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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    [Unpublished] 1984.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

    Validation of outpatient IMCI guidelines.

    United States. Agency for International Development [USAID]. Child Health Research Project

    SYNOPSIS. 1998 Jan; (2):1-8.

    The World Health Organization (WHO)/UN Children's Fund (UNICEF) Integrated Management of Childhood Illness (IMCI) guidelines were designed to maximize detection and appropriate treatment of illnesses due to the most common causes of child mortality and morbidity in developing countries: pneumonia, diarrhea, malaria, measles, bacterial infections in young infants, malnutrition, anemia, and ear problems. The health worker first examines the child and checks immunization status, then classifies the child's illness and identifies the appropriate treatment based on a color-coded triage system. By May 1997, 17 countries had introduced IMCI and 16 others were in the process of introduction. This issue reports on field tests of the guidelines conducted in Kenya, the Gambia, Uganda, Bangladesh, and Tanzania. Health workers who used the guidelines performed well when compared to physicians who had access to laboratory and radiographic findings as well as health workers trained in full case management. Of concern, however, are research findings suggesting the potential for overdiagnosis in some disease classifications. Current IMCI research priorities include the following: 1) determining health workers' ability to learn to detect lower chest wall indrawing; 2) identifying clinical signs to increase the specificity of referral for severe pneumonia; 3) identifying other clinical signs to increase the specificity of hospital referrals, thereby reducing unnecessary referrals; 4) investigating how clinical care for severely ill children could be expanded in areas where referral is not feasible; 5) finding ways to increase the specificity of the diagnosis of malaria; and 6) recognizing clinical signs to increase the specificity of the diagnosis of severe anemia and the specificity of the diagnosis of moderate or mild anemia, with the possible goal of regional adaptation of the anemia guidelines.
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  4. 4

    New developments in vaccinology.

    Andre FE

    ANALES ESPANOLES DE PEDIATRIA. 1992 Jun; 36 Suppl 48:189.

    New vaccine developments will reflect achievements of the World Health Organization's (WHO) Expanded Programme on Immunization (EPI), as well as resistance from the public toward increasing numbers of vaccines. WHO's EPI program has concentrated on tuberculosis, diphtheria, tetanus, whooping cough, polio, and measles. 35 countries are attempting to control hepatitis B with universal vaccination. Now some countries are also recommending vaccination against Haemophilus influenza, mumps, and rubella. The complexity of multiple injections has prompted new research on acellular vaccines for pertussis, hepatitis A and B, varicella, and malaria. Combined vaccines and new adjuvants are also targets of intense research. Vaccines are a priority, because they are among the most cost-effective of medical interventions.
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  5. 5

    EPI target diseases: measles, tetanus, polio, tuberculosis, pertussis, and diphtheria.

    Rodrigues LC

    In: Disease and mortality in Sub-Saharan Africa, edited by Richard G. Feachem, Dean T. Jamison. Oxford, England, Oxford University Press, 1991. 173-89.

    In Sub-Saharan Africa (SSA), 1% of all children die of neonatal tetanus, 9% of measles, 3% of tuberculosis (TB), and 4% of pertussis. Further, .6% acquire paralytic polio. 20% of the .6% who acquire diphtheria die. Even though vaccination can control these diseases, only 20% of children in SSA receive the complete course of vaccination against the 6 diseases targeted by WHO's Expanded Programme on Immunization (EPI). But high vaccine coverage is not always a cure-all. For example, in the Gambia coverage is high but high mortality levels persist. Of the EPI diseases, measles is the greatest threat since it kills 2 million people annually in developing countries. Measles related mortality is highest in the 9 months following the disease. Even though tetanus is a major cause of death in neonates, tetanus also kills adults such as those that work with the land. Further the tetanus vaccination is effective in adults, but no adult program operates in SSA. Trained midwives reduce neonatal tetanus mortality by 76.6% and vaccination of pregnant mothers with 2 doses of tetanus toxoid reduces mortality 93.3%. Lameness surveys in SSA countries show that, contrary to earlier beliefs, paralytic polio is quite common (range 0.7-13.2). Administration of the oral polio vaccine and improved sanitation are responsible for a real fall in polio cases in the Gambia, the Ivory Coast, and Cameroon. TB was introduced into SSA in the 19th century. It mainly occurs in adults. The estimated life long risk of developing smear positive TB in SSA is 63. The case fatality rate of pertussis in the 1st year of life is high (3.2) and infants do no acquire maternal immunity against it, so the best control measures are early vaccination and identifying secondary cases among young siblings. Of the EPI diseases, scientists know the least about diphtheria in SSA. Its case fatality rate is high (11-38%) yet it is treatable. Primary problems of adequate vaccination coverage for the EPI diseases are managerial problems rather than technological.
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  6. 6

    Vaccination strategies in developing countries.

    Poore P

    VACCINE. 1988 Oct; 6(5):393-8.

    In developing countries, where economic development is lacking and literacy rates are low, priority must be given to primary health care and to the establishmend of sustainable health care delivery systems. The World Health Organization's Expanded Program of Immunization was designed with the goal of immunizing all children against measles, pertussis, tetanus, poliomyelitis, tuberculosis, and diphtheria by 1990. A second function of the immunization program is to establish a health care delivery system. Today 50% of infants receive 3 doses of diptheria/pertussis/tetanus and polio vaccines, and 70% receive at least 1 dose. Measles kills 2 million children every year. The standard strain of attenuated vaccine is given at 9 months, and 1 dose protects 95% of children for life. Tetanus kills 800,000 infants every year. The vaccine must be refrigerated, and 2 doses are essential. Tuberculosis kills 2 million children under 5 every year. The attenuated BCG vaccine should be given at birth, and a single dose confers some protection. Diphtheria is most common among poor, urban children in termperate climates, and 3 doses of toxoid at monthly intervals are recommended. Poliomyelitis paralyzes 250,000 children a year. 4 doses of live attenuated Sabin vaccine are recommended. The vaccine is very sensitive to heat. Other vaccines in use or being developed include yellow fever, meningococcus, Japanese B encephalitis, rubella, hepatitis B, cholera, rotavirus, pneumonococcus, and Haemophilus influezae. 2 problems that confront the delivery of health services, including immunization, are lack of funds and lack of access to susceptible populations. Approaches to the lack of funds problem include fee for service, taxation, beter management of existing resources, reallocation of health resources, and increased funding from donor nations. Approaches to the problem of access include vaccination whenever children come into contact with a health facility for any reason, channeling by members of the community, involvement of traditional healers and birth attendants, outreach services, mass campaigns, pulse technics, and financial incentives.
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