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  1. 1
    040626

    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    [Unpublished] 1980. 39 p. (EPI/GEN/80/1)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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  2. 2
    038104

    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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  3. 3
    040102

    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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  4. 4
    037360

    Vaccines and when to give them.

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

    Geneva, Switzerland, WHO, 1984. 37 p. (Immunization in Practice. A Guide for Health Workers who Give Vaccines. Module 1.; EPI/PHW/84/1)

    This module, a guide for health workers who give vaccines, explains what those who give vaccinations need to know about vaccines and when to give them. As health workers cannot learn all that they need from a book or from lectures, a "Trainer's Guide" includes suggestions for practical exercises as well as answers and comments for the questions and exercises in this module and the 6 other modules in the series. This module covers the following: the properties of the 6 Expanded Program Immunization (EPI) vaccines; how to look after vaccines in a health center; the immunization schedule; contraindications to immunization; and doses, courses, and side effects of the 6 vaccines. The EPI aims to immunize all children against 6 important infectious diseases that are very serious and can kill or cripple many children: poliomyelitis; measles; diphtheria; pertussis; tetanus; and tuberculosis. The module includes some practical exercises.
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  5. 5
    041359

    Status of EPI syringe and sterilization development: August 1983.

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

    [Unpublished] 1983. 10 p. (EPI/CCIS/83.7)

    At this time in many developing countries sterilization practices for syringes and needles which are used to provide immunizations remain unsatisfactory. Problems include the use of the same syringe to administer vaccines to different persons and inadequate sterilization methods. The project objective is to explore the economic and technical feasibility of 2 approaches to improve these problems: the development of inexpensive sterilizable plastic syringes and the development of steam sterilization methods which are effective and convenient. Laboratory tests now have been conducted on sterilizable plastic syringes from 3 manufacturers and on pressure sterilizers from 2 manufacturers. The syringes gave satisfactory performance after 200 sterilizations equivalent to about 1 year's full use. The sterilizer tests demonstrated that 20 minutes of steam pressure is adequate to achieve sterilization. Field trials are to be conducted in up to 5 countries during 1983 and 1984 and results are expected to be published by the end of 1984. 0.1 ml single dose, sterilizable plastic BCG syringes were developed by 2 manufacturers, and prototype glass 0.1 ml syringes were made by 1 manufacturer. These syringes were tested in the laboratory together with a standard 1.0 ml glass BCG syringe and 2 sterilizable plastic 1.0 ml syringes intended for use with DPT, tetanus, and measles vaccines. The results of these tests are summarized in Table 1, and the test protocol appears in Annex 1. The sole recurring problem identified by field workers was the difficulty in releasing air bubbles from the syringe. 2 manufacturers were selected out of 13 manufacturers of domestic pressure cookers who demonstrated high performance in European and North American consumer tests. Sterilizers of 2 sizes were developed by modifying domestic pressure cookers to oeprate at temperatures between +121-132 degrees centigrade. Racks were developed to suspend syringes, needles, and other immunization instruments to hold them securely during transport yet also to offer easy access during the immunization session. The sterilizers were tested for steam distribution, safety, fuel consumption, and sterilizing performance; the results are summarized in Table 2.
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