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  1. 1

    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    [Unpublished] 1984.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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  2. 2

    Report of the Expanded Programme on Immunization Global Advisory Group Meeting, 20-23 October 1980, Geneva.

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

    [Unpublished] 1980. 39 p. (EPI/GEN/80/1)

    This report of the Expanded Program on Immunization (EPI) Global Advisory Group Meeting, held during October 1980 in Geneva, Switzerland, presents conclusions and recommendations, global and regional overviews, working group discussions, and outlines global advisory group activities for 1981. In terms of global strategies, the EPI confronts dual challenges: to reduce morbidity and mortality by providing immunizations for all children of the world by 1990; and to develop immunization services in consonance with other health services, particularly those directed towards mothers and children, so they can mutually strengthen the approach of primary health care. Increased resources are needed to support the expansion of immunization services and to establish them as permanent elements of the health care system. The Global Advisory Group affirms the importance of setting quantified targets as a basic principle of management and endorses the principle of setting targets for the reduction of the EPI diseases at national, regional, and global levels. The primary focus for the World Health Organization (WHO) in promoting the EPI continues to be the support to national program implementation in all its aspects. The Group reviewed current EPI immunization schedules and policies and concurs in the following: for measles, for most developing countries, the available data support the current recommendations of administering a single dose of vaccine to children as early as possible after the child reaches the age of 9 months; for DPT, children in the 1st year of life should receive a series of 3 DPT doses administered at intervals of at least 1 month; for tetanus toxoid, the control of neonatal and puerperal tetanus by immunizing women of childbearing age, particularly pregnant women, is endorsed; for poliomyelitis, the Group endorses the "Outline for WHO's Research on Poliomyelitis, Polioviruses and Poliomyelitis Vaccines" prepared by the WHO Working Group convened in October 1980, i.e., for oral (live) vaccines, a 3-dose schedule, administered simultaneously with DPT vaccine, is recommended again; and for BCG concurred with the Advisory Committee on Medical Research conclusion that the use of BCG as an anti-tuberculosis measure within the EPI should be continued as at present. The implementation of programs at the national level remains the foremost priority for the EPI. National commitment, evidenced in part by the designation of a national manager, the establishment of realistic targets, and the allocation of adequate resources, is essential if programs are to succeed.
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  3. 3

    Vaccination against tuberculosis. Report of an ICMR/WHO Scientific Group.

    World Health Organization [WHO]. Scientific Group on Vaccines Against Tuberculosis


    This document reports the discussions of a Scientific Group on Vaccination Against Tuberculosis, cosponsored by the Indian Council of Medical Research and the World Health Organization (WHO), that met in 1980. The objectives of the meeting were to review research on Bacillus Calmete-Guerin (BCG) vaccination, assess the present state of knowledge, and determine how to advance this knowledge. Particular emphasis is placed in this document on the trial of BCG vaccines in South India. In this trial, the tuberculin sensitivity induced by BCG vaccination was highly satisfactory at 2 1/2 months but had waned sharply by 2 1/2 years and the 7 1/2-year follow up revealed a high incidence of tuberculous infection in the study population. It is suggested that the protective effect of BCG may depend on epidemiologic, environmental, and immunologic factors affecting both the host and the infective agent. Studies to test certain hypotheses (e.g., the immune response of the study population was unusual, the vaccines were inadequate, the south Indian variant of M tuberculosis acted as an attenuating immunizing agent, and mycobacteria other than M tuberculosis may have partially immunized the study population) are recommended. A detailed analysis should be made when results from the 10-year follow up of the south Indian study population are available.
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  4. 4

    WHO Expert Committee on Tuberculosis: ninth report.

    World Health Organization [WHO]. Expert Committee on Tuberculosis


    This document represents the work of a World Health Organization (WHO) Expert Committee on Tuberculosis, which met in Geneva in 1973. Chapters in this volume focus on epidemiology, Bacillus Calmette-Guerin (BCG) vaccination, case finding and treatment, national tuberculosis programs, research, WHO activities in this field, and the activities of the International Union against Tuberculosis and voluntary groups. The Committee emphasized that tuberculosis still ranks among the world's major health problems, particularly in developing countries. Even in many developed countries, tuberculosis and its sequelae are a more important cause of death than all the other notifiable infectious diseases combined. The previous WHO report, issued in 1964, set forth the concept of a comprehensive tuberculosis control program on a national scale. The implementation of this approach has encountered many problems, including deficiencies in the health infrastructure of many countries (shortages of financial, material, and physical resources and a lack of trained manpower) and resistance to change. However, many countries have instituted comprehensive programs and tuberculosis control has become a widely applied community health activity. A priority will be control of pulmonary tuberculosis. The Committee stressed that national programs must be countrywide, permanent, adapted to the expressed demands of the population, and integrated in the community health structure. Steps involved in setting up such programs include planning and programming, selection of technical policies, implementation, and evaluation. Research priority areas identified by the Committee include epidemiology, bacteriology and immunology, immunization, chemotherpy, the systems analysis approach to tuberculosis control, and training methods and instructional materials.
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  5. 5

    Undoing the curse of neo-natal tetanus.

    Robbins K

    CHILD SURVIVAL ACTION NEWS. 1988 Apr; (9):1-2.

    Present thinking regarding the control of neonatal tetanus (NT) suggests that the accepted protocol in the past, i.e., immunizing pregnant women with tetanus toxoid (TT) during antenatal care, is not sufficient in countries where antenatal care may be unavailable. Current control strategies, experts, and official World Health Organization (WHO) recommendations now indicate that efforts should reach beyond immunization of pregnant women and the training of traditional birth attendants in hygienic cord care practice to immunization of all women of childbearing age. Babies continue to die form NT because it is so difficult to reach women during pregnancy for immunization. Lack of commitment to expanding immunization programs as Who recommends stems in part from failure at both national and local levels to acknowledge the extent of the neonatal tetanus problem. NT is vastly underreported for several reasons: cultural practices often include the seclusion of women and their babies during the period after birth; people in developing countries have a fatalistic attitude because so many children die within the 1st year of life; newborns are rarely taken to health centers for treatment; health workers may fail to report NT for fear that their superiors will blame them for failure to immunize or for poor care of the umbilical cord; Western medicine and research has a curative rather than a preventive focus; and gathering information on NT by asking mothers to recall deaths of newborns with symptoms of NT is difficult because many women are ashamed or otherwise unwilling to report the event. The WHO believes that conventional reporting systems in developing countries identify only 2-4% of actual NT cases. Without sound documentation of the problem, it is difficult to gain financial and political commitment to eradicating NT. The VIII International Conference on Tetanus that occurred in Leningrad during 1987 outlined WHO's recommendation for a mixed strategy to control and eliminate tetanus: immunize all women of childbearing age, with special emphasis on pregnant women and women known to belong to high risk groups; assure hygienic delivery and umbilical care through training and supervision of birth attendants; and investigate cases to determine what action could have prevented them.
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  6. 6

    Yellow fever vaccination in the Americas.


    Outbreaks of yellow fever in recent years in the Americas have prompted concern about the possible urbanization of jungle fever. Vaccination, using the 17D strain of yellow fever virus, provides an effective, practical method of large scale protection against the disease. Because yellow fever can reappear in certain areas after a 2-year dormancy period, some countries maintain routine vaccination programs in areas where jungle yellow fever is endemic. The size of the endemic area (approximately half of South America), transportation and communication difficulties, and the inability to ensure a reliable cold chain are problems facing these programs. In addition, the problem of reaching dispersed and isolated populations has been addressed by the use of mobile teams, radio monitoring, and educational methods. During yellow fever outbreaks, many countries institute massive vaccination campaigns, targeted at temporary workers and migrants. Because epidemics in South America may involve extensive areas, these campaigns may not effectively address the problem. The ped-o-jet injector method, used in Brazil and Colombia, should be used in outbreak situations, as it is effective for large-scale vaccination. Vaccine by needle, suggested for maintenance programs, should be administered to those above 1 year of age. An efficient monitoring method to avoid revaccination, and to assess immunity, should be developed. The 17D strain produces seroconversion in 95% of recipients, and most is prepared in Brazil and Colombia. But, problems with storage methods, instability in seed lots, and difficulties in large-scale production were identified in 1981 by the Pan American Health Organization and WHO. The group recommended modernization of current production techniques and further research to develop a vaccine that could be produced in cell cultures. Brazil and Colombia have acted on these recommendations, modernizing vaccine production and researching thermostabilizing media for yellow fever vaccine.
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  7. 7

    A perspective on controlling vaccine-preventable diseases among children in Liberia.

    Weeks RM

    INFECTION CONTROL. 1984 Nov; 5(11):538-41.

    In 1978 the Ministry of Health and Social Welfare (MHSW) of Liberia launched the Expanded Program on Immunization (EPI) with the 5-year objective of establishing an 80% reduction in child mortality and morbidity from measles, polio, diphtheria, neonatal tetanus, pertussis, and tuberculosis. The program at first adopted a strategy of using 15 mobile units in 11 operational zones to deliver vaccinations throughout the country. However, by 1980, despite support from the Baptist World Alliance, the UN International Children's Emergency Fund (UNICEF), and the World Health Organization (WHO), it became evident that the mobile strategy was neither economically feasible nor practical. Therefore, with support from the US Agency for International Development (USAID), the EPI shifted to a strategy of integrating immunization activities into the existing network of state health facilities. After 5 years, in 1982, the Program was evaluated by a team from the MHSW, WHO, USAID, and the Centers for Disease Control. The evaluating team felt that the EPI's strategy was good, but its goals were not being achieved due to deficiencies in funding, clinic supervision, and rural community outreach, as well as shortages of kerosene and spare parts needs to keep the essential refrigerators in operating condition. Measles remains endemic; in the capital, Monrovia, only 9% of the children have been vaccinated against it. Immunization coverage is particularly low in the capital the countries. Other reasons for low vaccination coverage in Liberia are lack of community awareness of existing facilities and the importance of vaccination and lack of coordination at the community level to use the existing facilities efficiently. International assistance is still needed, especially to develop heat-stable vaccines, so that maintenance of refrigerators will not be necessary.
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  8. 8

    [Acquired immunodeficiency syndrome (AIDS): WHO meeting and consultation on the safety of blood and blood products] Syndrome d'immunodeficit acquis (SIDA): reunion et consultation de l'OMS sur la securite du sang et des produits sanguins.

    Weekly Epidemiological Record / Releve Epidemiologique Hebdomadaire. 1986 May; 61(18):138-40.

    The World Health Organization (WHO) convened a meeting of experts on April 14-16, 1986, to review the available information on the safety of blood and blood products in relation to acquired immunodeficiency syndrome (AIDS). It was attended by over 100 participants from 34 countries and followed by a consultation which took into consideration previous recommendations, new information, and many different circumstances which exist regarding AIDS at the global level. This discussion reports the main conclusions and recommendations of the consultation. Tests to detect antibody to the AIDS virus now are available to assist in the elimination of potentially infectious units of blood and plasma, yet it is important to recognize that information and education remain crucial elements in any AIDS prevention program and that they continue to be relevant to the safety of blood and blood products. In that respect, measures to limit the transmission of LAV/HTLV-III by whatever means will be most effective in communities which are as well informed as possible about the disease, how it is transmitted, and how donors can assist in assuring a safe blood supply by being alert to donor suitability criteria. In some countries risk factors for AIDS have been identified in homosexual and bisexual men, intravenous drug abusers, and their sexual partners. Self-exclusion systems in which persons with risk factors refrain from giving blood, and blood screening programs for virus antibody have been effective in contributing to a safe blood supply. Experience also has shown that frequently when persons infected with the AIDS virus have donated blood, risk factors could later be identified, but many of those donors may not have recognized or acknowledged that they carried a risk. The value of specific screening and control measures which have been found useful in many developed countries should be assessed by other countries in the context of their overall health programs and the availability of human and material resources. Well-accepted general principles concerning the use of blood and blood products need to be emphasized since they can contribute to the control of AIDS. The most important principles are: strategies of health services such as improved antenatal care can reduce the demand for blood and should be encouraged; when appropriate and safer components and derivatives can be produced and are available, they are preferable to whole blood or plasma; and whole blood or plasma should be transfused only when medically justified. Decisions to institute laboratory screening of donors should be made with full awareness that there are several essential components of such a program. Information and education for donors about AIDS, its risk factors, and blood transmission is one of the basic considerations. Exclusion based on a current history of possible exposures to known risk factors as well as symptoms can help to reduce the number of infected donors.
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  9. 9
    Peer Reviewed

    Developments in pertussis vaccines: memorandum from a WHO meeting.

    Griffiths E; Kreeftenberg JG


    The WHO memorandum outlines the present situation regarding pertussis vaccines, discusses ways to evaluate candidate vaccines, and identifies future research needs. Most existing whooping cough vaccines are whole-cell vaccines, combined with diphtheria and tetanus toxoid adsorbed on an aluminum or calcium carrier. As whole bacterial cells, they contain a complex array of at least 7 toxins and antigens, and display a narrow margin between potency and toxicity. The Japanese introduced an acellular vaccine, admittedly sometimes less potent, called the Precipitated Purified Pertussis Vaccine, in 1981. This material contains far less bacterial mass, notably less endotoxin, and consequently produces less fever, erythema and induration. WHO has not yet established minimum requirements for standardization; even the mouse potency assay may not be suitable. There are techniques, however, which will measure amounts of component antigens and toxicity. Conflicting results on assays of potency and immunogenicity will have to be resolved. Besides the obvious need for large clinical trials of defined vaccines, a whole range of research needs were suggested, from genetic studies of the organism to specific details of the host response. It is generally agreed that a less reactogenic and more effective pertussis vaccine is needed and feasible.
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  10. 10

    Global overview: the Expanded Programme on Immunization, Cartagena, Colombia, 14-16 October 1985.

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

    [Unpublished] 1985. 15 p.

    This paper reviews the development of the global Expanded Program on Immunization (EPI) initiative, reports on program progress since the 1984 EPI conference, and identifies actions needed to meet the goal of providing immunization services to all children of the world by 1990. The central EPI strategy to date has been to deliver immunization in consonance with other health services, particularly those aimed at mothers and children. The long-term goal of such efforts is to strengthen the health infrastructure so as to ensure the continuous provision of immunization and other primary health care services. Simply by reinforcing existing health services, a coverage level of 60-70% will be achieved in developing countries by 1990. If universal coverage is to be achieved, external funds will have to be provided to meet operational costs and train national managers. Acceleration of existing efforts constitutes the main EPI priority at present. Specific areas suggested for immediate action include provision of information about immunization at every health contact; a reduction in the drop-out rates between 1st and last immunization; increased attention to the control of measles, poliomyelitis, and neonatal tetanus; improved immunization services to the disadvantaged in urban areas; and, where appropriate, acceleration of the EPI through approaches such as national immunization days. Ongoing actions that need to be pursued include strengthening disease surveillance and outbreak control, reinforcing training and supervision, and pursuing applied research and development. Overall, management capacity within national programs remains the most severe constraint for the EPI.
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  11. 11

    Local Area Monitoring (LAM).

    Kirsch TD


    Routine surveillance of the incidence of vaccine-preventable diseases has not proved sensitive enough to demonstrate the impact of the Expanded Program on Immunization (EPI) in many countries. In order to document progress since the start of the EPI in 1979, data are needed for several years prior to that. In most developing countries these can be found only in major cities or large hospitals. Therefore a system of sentinel surveillance, the Local Area Monitoring Project (LAM), is being set up in selected institutions in the major cities of the developing world. The primary goal of the LAM project is to provide disease-incidence data of sufficient quality to evaluate more fully the global impact of the EPI on the 6 target diseases--diptheria, pertusis, tetanus, poliomyelitis, measles, and tuberculosis. The goal is to include the major city of each of the 25 largest developing countries, with a total population of 115 million. These 25 countries together account for 85% of all births in the developing world. The program and coverage information is used to assess the impact of individual EPI programs on disease trends. Preliminary analysis of the 12 cities with the best data suggests that the impact of the EPI on the incidence of the target diseases has been greater than previously shown by the routine system. The LAM information is useful for global and regional analysis of program impact, but for the countries themselves its utility may be even greater. It is hoped that the project will help to improve a country's surveillance system by encouraging the use of sentinel reporting as a means of supplementing routine data. The information on the impact of the EPI may further increase political and public support for a program. (Summaries in ENG, FRE)
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  12. 12

    EPI in the Americas. Report to the Global Advisory Group Meeting, Alexandria, Egypt, 22-26 October 1984.

    Pan American Health Organization [PAHO]

    [Unpublished] 1984. 15 p.

    This discussion of the Expanded Program on Immunization (EPI) in the Americas covers training, the cold chain, the Pan American Health Organization's (PAHO) Revolving Fund for the purchase of vaccines and related supplies, evaluation, subregional meetings and setting of 1985 targets, progress to date and 1984-85 activities, and information dissemination. All countries in the Region of the Americas are committed to the implementation of the EPI as an essential strategy to achieve health for all by 2000. During 1983, over 2000 health workers were trained in program formulation, implementation, and evaluation through workshops held in Argentina, Brazil, Cuba, El Salvador, and Uruguay. From the time EPI training activities were launched in early 1979 through 3rd quarter 1984, it is estimated that at least 15,000 health workers have attended these workshops. Over 12,000 EPI modules have been distributed in the Region, either directly by the EPI or through the PAHO Textbooks Program. The Regional Focal Point for the EPI cold chain in Cali, Colombia, continues to provide testing services for the identification of suitable equipment for the storage and transport of vaccines. The evaluation of solar refrigeration equipment is being emphasized increasingly. PAHO's Revolving Fund for the purchase of vaccines and related supplies received strong support from the UN International Children's Emergency Fund (UNICEF), which contributed US $500,000, and the government of the US, which contributed $1,686,000 to the fund's capitalization. These contributions raise the capitalization level to US $4,531,112. Most countries are gearing their activities toward the increase of immunization coverage, particularly to the high-risk groups of children under 1 year of age and pregnant women. To evaluate these programs, PAHO has developed and tested a comprehensive multidisciplinary methodology for this purpose. Since November 1980, 18 countries have conducted comprehensive EPI evaluations. 6 countries also have had followup evaluations to assess the extent to which the recommendations from the 1st evaluation were implemented. At each subregional meeting, participants met in small discussion groups to review each other's work plans and discuss appropriate targets for the next 2 years. Immunization coverage has improved considerably in the Americas over the last several years. Figure 2 plots the incidence rates of polio, tetanus, diphtheria, whooping cough, and measles from 1970-83 in the 20 countries which make up the Latin American subregion. If all countries meet their 1985 targets, immunization coverages for DPT and polio will range from 60-100%, with most countries attaining coverages of over 80%. For measles, 1985 targets range from 50-95%, and from 70-99% for BCG. The main vehicle for dissemination of information is the "EPI Newsletter," which publishes information on program development and epidemiology of the EPI diseases.
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  13. 13

    [Experience with the expanded WHO program on immunization against tetanus] Opyt rasshirennoi programmy VOZ po immunizatsii protiv stolbniaka.

    Litvinov SK; Lobanov AV


    According to (WHO) statistics, over 1 million infants in the developing countries die each year from tetanus. The estimated annual occurrence of tetanus in the 3rd World exceeds 2.5 million cases, including approximately 1.3 million newborn infants. In 1974, WHO began an expanded program for the systematic immunization of infants against tetanus and certain other diseases. The program uses 2 approaches for preventing tetanus: 1) immunization of infants under 1 year of age with the AKDS vaccine; and 2) immunization of pregnant women or, if possible, all women, with tetanus anatoxin. The 2nd approach is more effective, especially when 2 doses of tetanus anatoxin are administered within a minimum interval of 4 weeks. The anatoxin has no harmful effects on the fetus and can be used during any stage of pregnancy. The program strives to reduce infant mortality caused by tetanus to less than 1 case in 1000 by 1990, and to 0 by 2000. To attain these goals, systematic immunization should be combined with drastic improvements in delivery techniques and hygiene in developing countries. Specialized surveys indicate that initial steps toward implementation of the program resulted in a significant reduction of infant mortality caused by tetanus. Experience with the expanded WHO program shows that elimination of tetanus in infants is a realistic and attainable goal.
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  14. 14

    [Expanded Programme on Immunization: Global Advisory Group] Programme Elargi de Vaccination: Groupe consultatif mondial.

    World Health Organization [WHO]

    Weekly Epidemiological Record / Releve Epidemiologique Hebdomadaire. 1984 Mar 23; 59(12):85-9.

    In addition to the conclusions and recommendations reached at the 6th meeting of the Expanded Program on Immunization (EPI) Global Advisory Group and summarized in this report, the Group reviewed at length the status of the program in the Western Pacific Region and made a series of recommendations specifically directed to activities in the Region. Of particular significance for the operational progress of the global program are the recommendations concerning "Administration of EPI Vaccines," which were subsequently endorsed by the Precongress workshop on Immunization held before the XVIIth International Congress of Pediatrics in Manila in November 1983. These recommendations are not listed here. In his report to the World Health Assembly in 1982, the Director-General summarized the major problems which threaten the success of efforts to achieve the World Health Organization (WHO) goal of reducing morbidity and mortality by providing immunization for all children of the world by 1990. The 5-Point Action Program adopted at that time remains a relevant guide for countries and for WHO as they work to resolve those problems. The EPI is concerned about the prevention of the target diseases, not merely with the administration of vaccine. In addition to working toward increases in immunization coverage, the EPI must assure the strenghtening of surveillance systems so that the magnitude of the health problem represented by the target diseases is known at the community, district, regional, and national levels; immunization strategies are continuously adapted in order to reach groups at highest risk; and the target diseases are reduced to a minimum. The development of surveillance systems is one of the priorities in the development of effective primary health care services. Disease surveillance in its various forms should be used at all management levels for monitoring immunization programs performance and for measuring program impact. Specific recommendations regarding disease surveillance to be undertaken at global and regional levels and at the national level are listed. The results of more than 100 lameness surveys conducted in 25 developing countries confirm that paralytic poliomyelitis constitutes an important public health problem in any area in which the disease is endemic. In most programs, initial emphasis should be placed on the develpment of sentinel surveillance sites to monitor disease incidence trends. Some progress has been made in acting on the recommendations made at the meeting on the prevention of neonatal tetanus held in Lahore in 1982, but intensification of activities is required. In many developing countries, the surveillance and control of diphtheria must be improved. All aspects of progress and problems in the global program are reflected at least somewhere in the Western Pacific Region, and most of the findings and recommendations generally are valid beyond the regional boundaries.
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  15. 15

    Neonatal tetanus mortality: the magnitude of the problem and prospects for its control.

    Hadjian A

    In: Medical education in the field of primary maternal child health care [edited by] M.M. Fayad, M.I. Abdalla, Ibrahim I. Ibrahim, Mohamed A. Bayad. [Cairo, Egypt, Cairo University, Faculty of Medicine, Dept. of Obstetrics and Gynecology, 1984]. 421-34.

    This paper begins by stating that the mortality from neonatal tetanus has been peculiarly underestimated until recently, and discusses why this has been the case. The availability of a methodology for retrospective surveys and undertaking of such surveys in recent years has thrown much light on the subject. The results of these surveys from 15 countries are presented in tabular form. It is apparent that at present between 500,000 and 1 million newborn infants a year succumb to tetanus. The prospects for control, using the combined approach of improved maternity care and maternal immunization, are discussed, and an appropriate schedule of immunization suggested. The prospects for control are good wherever there is realization of the magnitude of the problem plus reasonable access to even quite basic primary health care. Some activities of WHO in this field are briefly described. (author's)
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  16. 16

    [Expanded Programme on Immunization: stability of freeze dried measles vaccine] Programme Elargi de Vaccination: stabilite du vaccin antirougeoleux lyophilise.

    World Health Organization [WHO]

    Weekly Epidemiological Record / Releve Epidemiologique Hebdomadaire. 1981 Jun 12; 56(23):177-9.

    This report brings up to date those data summarized previously regarding the stability of freeze-dried measles vaccine and is based on information obtained from the London School of Hygiene and Tropical Medicine. The World Health Organization (WHO) intends to establish a requirement for the stability of freeze-dried measles vaccine, and a draft of such a requirement is represented along with an analysis of how such a requirement would influence WHO acceptance of the vaccine included in this report. A plaque assay method was used to determine the potency of measles vaccine which had been stored in a freeze-dried state at 37 degrees Centigrade for varying intervals. Vaccine containers were exposed at 37 degrees Centigrade in a water bath and duplicate samples transferred to -70 degrees Centigrade at intervals ranging from 1 to 28 days. The residual infectious virus was determined by the plaque assay method in parallel with vaccine that had not been incubated. The results from 16 patches produced by 9 manufacturers are summarized in a table, which includes recent data a well as the results from the previous report. 2 criteria of stability are included: the number of days required for the live virus titer to drop to an acceptable minimum level when stored at 37 degrees Centigrade (Criterion 1); and the loss of live virus titer when stored for 7 days at 37 degrees Centigrade (Criterion 2). Neither criterion is sufficient on its own. A quite unstable vaccine might still have the required potency after being stored for a week at 37 degrees Centigrade if the vaccine had a high virus titer initially. Yet, a product with satisfactory stability might still fail the potency requirement if its initial virus titer was borderline. A figure shows how the vaccines would be rated according to the proposed requirements. The proposed requirement for the stability of freeze-dried measles vaccine will be presented to the Expert Committee on Biological Standardization during its meeting in September 1981. If accepted, it would become effective by March 1982.
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  17. 17
    Peer Reviewed

    Strategy for rapid elimination and continuing control of poliomyelitis and other vaccine preventable diseases of children in developing countries.

    Sabin AB

    BMJ. British Medical Journal. 1986 Feb 22; 292(6519):531-3.

    Estimates of a recent yearly incidence of 400,000 cases of paralytic poliomyelitis, 2.5 million deaths from measles and its complications, over 1 million deaths from neonatal tetanus, and 735,000 deaths from pertussis in Asia, Africa, and Latin America now pose a greater challenge for new action than did the worldwide eradication of smallpox several years ago. By virtue of the conditions obtaining in the developing countries mere expansion or acceleration of what is being done now -- even with modifications that may achieve a temporary increase in vaccine coverage -- cannot achieve the desired rapid elimination and continuing control of these diseases. A new strategy -- namely, bringing the vaccine to the people during annual national days of vaccination -- has already been used successfully in some small and large developing countries of Latin America for the rapid elimination and continuing control of polio. This strategy could be adapted to include vaccination against measles, pertussis, and neonatal tetanus by additional training of community volunteers in the large auxiliary health armies that work with the existing health services each year. (author's)
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  18. 18

    Neonatal tetanus--a brief global review.

    Cook R

    In: The control of neonatal tetanus in India, edited by Indra Bhargava [and] Jotna Sokhey. New Delhi, India, Ministry of Health and Family Welfare, 1983. 16-23.

    Neonatal tetanus is relatively preventable either by the immunization of pregnant women or hygienic care of the umbilical stump. Nonetheless, the medical profession tends to place great emphasis on its treatment than prevention, and the global magnitude of the problem remains largely unknown. In many countries, few cases of neonatal tetanus reach the hospitals and the usual notification system shows only a fraction of total mortality from this disease; thus, retrospective surveys are regarded as the most practical way to arrive at reasonably accurate estimates of disease incidence. Results of these surveys suggest that between 500,000 and 1 million deaths from neonatal tetanus occur each year in the developing world (excluding China). Trials have indicated the effectiveness of a combined approach to neonatal tetanus including improved maternity care (especially through training traditional birth attendants) and immunization of future mothers with 2 doses of tetanus toxoid. The basic prerequisites for effective control seem to be 1) a primary health care network accessible to the majority of the population and 2) an awareness of the magnitude of the problem. Every opportunity should be taken to immunize women in the childbearing period of life; many pregnant women do not take advantage of prenatal care. The World Health Organization (WHO) has been involved in the prevention of neonatal tetanus since the late 1960s. To achieve its goal of virtually eliminating neonatal tetanus by the year 2000, WHO plans to 1) encourage further retrospective surveys, especially in areas where the scope of the problem is unknown, and 2) support the demonstration of a combined approach (improved maternity care and immunization) in areas with populations over 250,000.
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  19. 19

    WHO seeks global program against viral hepatitis.

    Bulletin of the Pan American Health Organization. 1983; 17(3):323.

    A World Health Organization (WHO) Consultative Group on Hepatitis met during July 1983 to draft a global program for viral hepatitis control. At this time, hepatitis viruses infects tens of millions of people every year. These viruses can be transmitted by the fecal-oral route, in blood or certain blood products, and through intimate personal contact. Of the various forms (heptitis A, hepatitis B, and hepatitis non-A, non-B) hepatitis B arouses particular concern because it can produce chronic liver disease and premature death. Currently, there are over 200 million persistent carriers of this virus, many of whom will die of chronic liver damage. Firm evidence recently shows a clear cause and effect relationship between infection with hepatitis B virus and primary liver cancer, a common cancer that claims hundreds of thousands of lives a year. The July meeting made recommendations to improve the situation. One of the most important recommendations was to strengthen national capabilities to control viral hepatitis. The group also reviewed available diagnosis and control methods and suggested areas where action by the WHO would be most effective. The group agreed that the availability of safe and effective vaccines against hepatitis B provides a unique opportunity to break the chain of transmission and to prevent acute and chronic liver disease, including primary liver cancer. There has been concern that the plasma-derived hepatitis B vaccines could contain transmissible agents that might be implicated in the acquired immune deficiency syndrome (AIDS). It was felt that much care needs to be taken in selecting plasma donors and in purifying the immunizing component of the vaccine, known as hepatitis B surface antigen, so as to ensure a very high degree of purity and freedom from all infectious agencts. No evidence exists at this time of AIDS transmission by any hepatitis B vaccine.
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    Possible prevention of liver cancer by vaccination.

    Bulletin of the Pan American Health Organization. 1983; 17(2):212.

    A World Health Organization (WHO) sponsored scientific meeting concludes that hepatitis B vaccine presents unique opportunities for preventing a common type of human cancer by vaccination. Should these prospects be realized, it would be the 1st time an important human cancer has been prevented in this way. The 5-day meeting, held in February 1983, brought together specialists in biostatistics, epidemiology, molecular biology, pathology, virology, and vaccine development and production from 16 countries. The topic at the meeting was liver cancer, one of the 10 most common cancers in the world and one of the most prevalent cancers in developing countries. The evidence for the implication of hepatitis B virus in the etiology of primary liver cancer is based upon epidemiologic and geographic observations of a strong association between hepatitis B infection and this form of cancer and also upon recent results of molecular biology studies showing integration of hepatitis B viral DNA into the host's genetic material. About 80% of all liver cancers are thought to occur as a result of infection with hepatitis B virus. Actual development of such cancers is believed to proceed through a series of intermediate stages, including establishment of a persistent infection with the virus, the hepatitis B carrier stage, and integration of the virus into the host genome. Worldwide, survival, and persistence of the hepatitis B virus depends on a huge reservoir of human carriers, estimated conservatively to number over 200 million. Prolonged "shedding" of the virus by a portion of these carriers and its transmission to others by various routes helps to account for the high incidence of the disease. In many parts of the world perinatal infection and infection in early life play a very important role in transmission and often lead to continuing infection. Feasibility studies conducted in recent years in several countries with 2 newly developed hepatitis B vaccines demonstrated that immunization of babies can prevent natural infection with hepatitis B virus and also can prevent development of a persistent hepatitis B infection. It seems an appropriate time to take international action to plan and initiate a number of field intervention trials with the new vaccines among populations known to have high prevalence of hepatitis B infection, the hepatitis C carrier state, and liver cancer.
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