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EPI in the Americas. Report to the Global Advisory Group Meeting, Alexandria, Egypt, 22-26 October 1984.
[Unpublished] 1984. 15 p.This discussion of the Expanded Program on Immunization (EPI) in the Americas covers training, the cold chain, the Pan American Health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.
WORLD HEALTH FORUM. 1982; 3(4):436-40.In this discussion of strengthening the vaccine cold chain, attention is directed to the following: preventing breakdowns (ensuring good performace, delivery and installation, and training users in maintenance) and repairing equipment (planning a maintenace system and suppliers of spare parts). Keeping vaccines continuously cold as they travel from the factory to the place where they are used calls for a "cold chain" of referigerators and cold boxes. In tropical countries with unreliable electricity supplies and without vehicles to carry the vaccines, this cold chain is highly vulnerable to interruption, with consequent loss of vaccine potency. Although the UN International Chilren's Emergency Fund, the World Health Organization, and many other agencies have spent hundreds of thousands of dollars in the past few years on equipment and training, vaccines continue to be damaged. Refrigeration engineers have produced many new ideas for keeping vaccines cold, including: refrigerators that regquire only 8 hours of electricity per day; an almost unbreakale lamp glass for use in kerosene refrigerator; freezers that can produce 40 kgof ice per day for cold boxes; and freezers that use bottled gas as fuel and are specially designed for making ice packs for cold boxes. Yet, the cold chain still fails. In a typical vaccine cold chain, between 30-50% of refrigerators and freezers are not working, due in part to refrigerators have a very short working life in tropical climates. The following recommendations should be followed whien buying and installing refrigerators or freezers for cold chain: mmake sure their performace is good enough; make sure the equipment is delivered and installed in good condition; and train users to look after the equipment properly. Even a perfectly maintained refrigerator or freezer eventually wiull break down. In a properly orgaized cold chain, the individual resonaible should then contact a repair workshop. Refrigerator and freezer repairs can be done in developing countries. The guidelines for ensuring prompt repairs consider both planning a maintenance system and storing the spare parts where they will be used. There are 2 options for ministries of health who want to improve their cold chain repair work: they can award a contract for the work to a private compan; they can do the work themselves. All the work that has been done on training, tool kit design, and spare parts is based on the assumption that countries have a national policy on maintenace and repair of cold chain rquipment. This is the responsibility of the ministry of health, and there must be a commiTMENT TO THIS POLICY IN THE HIGHEST LEVELS OF THE MINISTRY.