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Eradication of indigenous transmission of wild poliovirus in the Americas. Plan of action, July 1985.
[Washington, D.C.], PAHO, 1985 Jul. 26 p. (EPI-85-102; CD31/7 Annex II)The Pan American Health Organization (PAHO) appointed a Technical Advisory Group (TAG) which met in July 1985 to plan eradication of wild poliovirus in the Americas by 1990 by immunization and surveillance. The strategies to be adopted are mobilization of national resources; vaccine coverage of 80% or more of the target population; surveillance to detect all cases; laboratory diagnosis; information dissemination; identification and funding of research needs; development of a certification protocol; and evaluation of ongoing program activities. The expanded immunization program (EPI) will be organized at the country level by setting up National Work Plans, with inventories of resources and identification of participating agencies and donors, under the guidance of national EPI offices. The TAG will be composed of a core of 5 experts on immunization, with additional consultants as needed, meeting quarterly, semi-annually or annually to review progress and publish recommendations. Regional EPI offices will coordinate eradication activities between the Ministries of Health, the 10-11 epidemiologists/technical advisors in each country and all agencies affiliated with the PAHO. Support personnel will be available at the sub-regional and regional level, including support virologists to assist the laboratory network. Appendices are attached showing estimated costs for regional and regional personnel, vaccines, laboratories, and program activities, predicting that the effort will pay for itself 2.3 times over by 2000.
REVIEWS OF INFECTIOUS DISEASES. 1983 May-Jun; 5(3):546-53.Control of measles in tropical Africa has been attempted since 1966 in 2 large programs; recent evaluation studies have pinpointed obstacles specific to this area. Measles epidemics occur cyclically with annual peaks in dry season, killing 3-5% of children, contributing to 10% of childhood mortality, or more in malnourished populations. The 1st large control effort was the 20-country program begun in 1966. This effort eradicated measles in The Gambia, but measles recurred to previous levels within months in other areas. The Expanded Programme on Immunization initiated by WHO in 1978 also included operational research, technical assistance, cooperation with other groups such as USAID, and development of permanent national programs. Cooperative research has shown that the optimum age of immunization is 9 months, and that health centers are more efficient at immunization, but mobile teams are more cost-effective as coverage approaches 100%. 53 evaluation surveys have been done in 17 African countries on measles immunization programs. Some of the obstacles found were: rural population, underdevelopment of infrastructure, and exposure of unprotected infants contributing to the spread of measles. Measles surveillance is so poor that less than 10% of expected cases are reported. People are apathetic or unaware of the importance of immunization against this universal childhood disease. Vaccine quality is a serious problem, both from the lack of an adequate cold chain, and lack of facilities for testing vaccine. The future impact of measles control from the viewpoint of population growth and health of children offers many fine points for discussion.