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Bulletin of the World Health Organization. 1954; 11:201-228.The information contained in the table that follows was obtained from a questionnaire sent by WHO in June 1953 to all Member States in order to elicit information on the types of health statistics and related vital statistics that are available in different countries, how they are obtained, and to what extent they are made available to the international organizations. The questionnaire asked for information on causes of death, causes of foetal death, and notifiable diseases, in addition to the subjects listed in the table. It will be seen that only a certain number of countries answered fully that part of the questionnaire with which we are concerned here. The reason is fairly obvious: statistics pertaining to health in its various aspects are numerous, varied, and scattered among many government departments apart from the health administrations--for instance, among the ministries of social welfare (social insurance returns, hospital statistics), of defence (army, navy, and air force health statistics), and of education (school medical inspection, number of students and graduates in medicine and in allied professions). To compile a complete inventory of existing health statistics would require many months of patient search in publications and reports and correspondence with the many national administrations concerned. (excerpt)
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.
[Unpublished] 1984.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.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1980; (651):1-19.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.
Bulletin of the World Health Organization. 2000; 78(8):1062-3.According to the report of the UN International Children's Emergency Fund (UNICEF), worldwide diphtheria, pertussis, tetanus, and poliomyelitis vaccination programs are still failing to reach millions of children in the developing world, particularly in Africa. It is noted that in developing countries 370,000 children below 5 years of age die from whooping cough and another 50,000 die from tuberculosis every year. Moreover, more than half of the infants born are unprotected against tetanus and 200,000 die from the disease. The report reveals that a large part of the problem is related to inadequate funding and the high cost of initiating broad-based programs. While the reports widely credits UNICEF with promoting vaccination efforts in developing countries, it also points to several private and public-private efforts, including the commitment of US$750 by the Bill and Melinda Gates Foundation for the development of the Global Alliance for Vaccines and Immunization.
Childhood tuberculosis and infection with the human immunodeficiency virus. BCG immunization for HIV-seropositive newborns.
PEDIATRIC PULMONOLOGY. 1997; Suppl 16:157-9.HIV infection has been recognized as a risk factor for the progression of Mycobacterium tuberculosis infection to disease. Newborn infants are especially vulnerable to tuberculosis (TB) when a member of their family, such as the mother, has active TB. The first and main strategy for preventing TB in children is case finding, early diagnosis, and timely treatment to improve the cure rate in adult and pediatric TB, in a bid to remove a substantial portion of infection sources. Another strategy is wide-scale BCG vaccination in countries with high prevalence of TB. Chemoprophylaxis with isoniazid at a dose of 5 mg/kg is used for at least 1 year. Routine BCG immunization after birth is applied in most developing countries with active TB control programs. Argentina, a country with moderate TB prevalence, follows World Health Organization recommendations to vaccinate all children born to HIV-infected mothers against TB, except for those children with symptomatic HIV disease. This practice of routine immunization is under review.
WORLD HEALTH FORUM. 1998; 19(2):162-73.In 1796, English country doctor Edward Jenner demonstrated that scratching cowpox virus onto the skin produced immunity against smallpox. Following this scientific demonstration, the practice of vaccination gradually became widespread during the 19th century, and began to be applied to other infections. However, the use of vaccines was largely confined to the industrialized countries. Immunization played no significant role in the World Health Organization's (WHO) early activities. In 1974, however, WHO launched its Expanded Program on Immunization (EPI) with the goal of immunizing all of the world's children against diphtheria, pertussis, tetanus, measles, poliomyelitis, and tuberculosis. At that time, only less than 5% of all children had been immunized against the diseases. The word "expanded" referred to the addition of measles and poliomyelitis to the vaccines then being used in the immunization program. Now, 80% of the world's children receive such protection against childhood diseases during their first year of life, coverage could reach 90% by 2000, vaccines are becoming more effective, and vaccines against additional diseases are being added to the program.
CURRENT OPINION IN IMMUNOLOGY. 1993 Oct; 5(5):683-6.The author reviews successes and failures in international immunization programs. Although the eradication of smallpox was no small feat, the existence of particularly favorable factors pertinent to its control helped. The Pan American Health Organization proposed in 1985 efforts to eradicate the indigenous transmission of wild-type poliovirus from the Americas by the year 1990. By February 1993, no cases of poliomyelitis had been reported in the Americas for 18 months. This rapid success is remarkable given the comparatively difficult obstacles inherent to the eradication of polio. The goal of eradicating poliovirus was extended to the global level by the World Health Assembly in 1988 for realization by the year 2000. On measles, the World Health Organization Expanded Program on Immunization (EPI) aims to reduce its reported incidence by 90% and mortality by more than 95%, compared with pre-EPI levels, by 1995. More research and maybe a different vaccine are needed, however, given controversy over the use of high-titer vaccine. Mycobacteria which cause leprosy and tuberculosis have long been of minor importance in most developed countries and are controlled with drugs. Elsewhere, more effective vaccines than BCG must be developed and brought to bear against tuberculosis. The author also considers the immunological, delivery, production, efficacy testing, and ethical and social obstacles to developing and implementing HIV vaccines in the Third World. Fertility control vaccines are discussed in closing.
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.
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.
FRONT LINES. 1991 Nov; 16.Indonesia's success in reaching World Health Organization (WHO) universal immunization coverage standards is described as the result of a strong national program with timely, targeted donor support. USAID/Indonesia's Expanded Program for Immunization (EPI) and other USAID bilateral cooperation helped the government of Indonesia in its goal to immunize children against diphtheria, pertussis, tetanus, polio, tuberculosis, and measles by age 1. The initial project was to identify target areas and deliver vaccines against the diseases, strengthen the national immunization organization and infrastructure, and develop the Ministry of Health's capacity to conduct studies and development activities. This EPI project spanned the period 1979-90, and set the stage for continued expansion of Indonesia's immunization program to comply with the full international schedule and range of immunizations of 3 DPT, 3 polio, 1 BCG, and 1 measles inoculation. The number of immunization sites has increased from 55 to include over 5,000 health centers in all provinces, with additional services provided by visiting vaccinators and nurses in most of the 215,000 community-supported integrated health posts. While other contributory factors were at play, program success is at least partially responsible for the 1990 infant mortality rate of 58/1,000 live births compared to 72/1,000 in 1985. Strong national leadership, dedicated health workers and volunteers, and cooperation and funding from UNICEF, the World Bank, Rotary International, and WHO also played crucially positive roles in improving immunization practice in Indonesia.
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.
[Unpublished] 1988. Presented at the 13th World Conference on Health Education, Houston, Texas, August 28 - September 2, 1988. 60 p.This study is the report of a 1986 baseline survey, guided by the World Health Organization's "Guidelines for a Sample Survey of Diarrheal Diseases Morbidity, Mortality, and Treatment Rate." The survey method was the Expanded Program on Immunization 30 cluster 2-stage method. Baseline data were also gathered on the status of immunization against diphtheria, tetanus, whooping cough, poliomyelitis, measles, and tuberculosis. Primary health care services in Bahrain are generally good. The archipelago of 670 sq km has a population of 417,210 including 55,000 children under 5. There are 18 health centers and 480 physicians or 1 physician for every 860 people. All inhabitants of a catchment area live within 5 km of a health center, and medical care is free. Diarrhea is due to a number of different organisms, including typhoid, paratyphoid, salmonellosis, Escherichia coli, rotaviruses, and giardiasis, but there has been no cholera in Bahrain since 1979. The national diarrheal diseases control program, drafted by the World Health Organization in 1985, emphasized the use of oral rehydration therapy, breast feeding, and feeding during diarrhea. No vaccinations are compulsory in Bahrain, but immunization coverage has been reported annually since 1981, and vaccinations are in line with the World Health Organization's criteria. Diphtheria-Typhoid-Paratyphoid vaccinations were 1st given in Bahrain in 1957; polio vaccination began in 1958 with Salk vaccine and in 1962 with the Sabin vaccine. Measles vaccination began in 1974. BCG vaccination has been given to children entering school since 1972. All health centers in the country offer vaccination services. Vaccines are stored under refrigeration, and the central supply is at the Public Health Directorate. Adverse effects of vaccinations are monitored. The 1986 diarrheal diseases survey, using the 30 cluster method, looked at a sample of 4114 children under 5 from 2515 households. 378 (9.2%) of the children suffered from diarrhea, and 200 (52.9%) were treated with oral rehydration salts. The under-5 diarrheal mortality rate was .97/1000. The estimated number of episodes of diarrhea per child per year is 2.4, with a high of 8.7 episodes in the Northern Region and a low of 1.2 episodes in the Muharraq Region. Vaccination coverage of children under 2 for other diseases was found to be 96.5% for diphtheria, paratyphoid, and typhoid; 95% for polio; 82.5% for measles; and 59.8% for the trivalent mumps, measles and rubella vaccine. 96.4% of all vaccinations were given in government hospitals. 98.7% of mothers have been examined during pregnancy, and 98.9% of all deliveries are in hospitals. It is recommended that a health education campaign be concentrated on diarrhea, breast feeding, feeding during diarrhea, and hygiene; that both medical staff and mothers be trained in the use of oral rehydration salts; that they should also be informed of the adverse effects of treating diarrhea with antibiotics; that a system for reporting cases of diarrhea be developed; that health education campaigns emphasize the importance of receiving booster doses of vaccines and of vaccination against measles; that staff at health centers adjust their schedules so as to be available for immunizations as needed; and that this survey be repeated every 2 years.
WORLD HEALTH STATISTICS QUARTERLY. RAPPORT TRIMESTRIEL DE STATISTIQUES SANITAIRES MONDIALES. 1988; 41(1):19-25.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)
WHO Chronicle. 1980 Mar; 34(3):118-9.The World Health Organization (WHO) plan is to hold 2 meetings with tuberculosis experts for the purpose of examining the implications of a large scale trial in the south of India that has shown no protection against lung tuberculosis from BCG vaccination. Launched in 1971, the trial covered some 260,000 persons older than age 1 month. It was aimed at preventing lung tuberculosis in the population of 209 villages as well as in a town in the district of Chingleput, west of Madras. Results with the BCG vaccines have varied in the scientifically valid controlled studies that have been conducted. The success of BCG vaccines has varied by population group, ranging from good (80% effectiveness) to poor (as in the Indian trial). The following were among the questions raised by the findings of the Indian trial: were there procedural flaws; were the BCG vaccines used of adequate potency; could other factors have played a role; and should BCG vaccinations be stopped. According to the published report, there were no apparent flaws in the procedures followed in the Indian study. In the Indian trial, 2 BCG strains--Danish and French--were used in the highest tolerated doses. The strains were selected for their relatively high efficacy in experimental studies, and extensive laboratory control showed the vaccines to be of good quality. The WHO experts found the epidemiology of tuberculosis in the trial area to be peculiar in the sense that the tuberculosis occurred long after an individual was infected. Not far from the trial area, and also in south India, disease occurred soon after infection. The experts noted that this phenomenon, which requires further study, may influence the effectiveness of vaccination. According to the experts, the findings in the study population were not applicable in other parts of India. Where many factors may play a role and when the level of protection is nonexistent, as in the India trial, little can be deduced about the worth of the vaccine and its effect under different circumstances.
Brazzaville, Congo, World Health Organization, Regional Office for Africa, 1979. 283 p.From 1965 to 1978, the author made numerous formal addresses in conjunction with his duties as the World Health Organization's (WHO) Regional Director for Africa. The addresses provide a theoretical and practical foundation for the development of a health care strategy and are grouped in sections concerning general policy, ways and means, health services delivery and development, disease control, and training and development of health team personnel. Health development in African nations demands planning for the implementation of health services to meet local community needs and appropriate training and utilization of health care personnel. The ultimate goal of health development is social justice, defined as the proper amount of health care available to all. The benefits will be realized in increased labor productivity and economic development, better quality of life, and self reliance in African nations. To achieve social justice, African nations must abandon foreign concepts of medical care and develop their own solutions to health problems that are realistic for their populations. Through the application of the techniques of scientific management and the development of cooperative international forums, these solutions can be discovered. Planning, aided by the development of information systems, research, and regional cooperation, is vital to assure both curative and preventive health programs are delivered that meet the health services needs of the population. Disease control is important to the economic development of African nations. Preventive action can be realized through planning and organized delivery of health services, including immunization programs, which enhance the population's general health status. Where prevention is not possible, early detection followed by swift response is an objective of effective health services. Training of health care and service personnel should focus on preparing professionals to contribute to the welfare of the community and to African development. The development of the health care team, which encompasses traditional and nontraditional personnel, adequately utilizes available resources and is responsive to both curative and preventive health needs.
Chronicles. 1983 Jun; 3(1):11-4.Analyzes the anti-tuberculosis (BCG) vaccine controversy. The vaccine was highly controversial at the beginning due to difficulties in standardization, maintenance of efficacy, and in the methods of applying the vaccine. Nevertheless, BCG gained increasing acceptance and is used widely in France, Germany, Norway, Sweden and Japan. It is also 1 of the vaccines regularly employed in the worldwide immunization campaign of the World Health Organization. A number of well controlled prospective studies have been done in the last 50 years in several countries to determine the efficacy of BCG. The studies give contradictory results which may prove that under certain conditions, BCG has a clear protective effect against infection from human virulent tubercle bacilli. The 1982 evaluation after 10 years showed a 45% protective efficacy. On the basis of an extended review of BCG vaccination, it is recommended that the use of BCG be continued. However, there are situations where the effectiveness of BCG cannot be predicted with certainty, and it is recommended that every effort be made to identify local factors that may modify the outcome of BCG vaccination. The worldwide tuberculosis problem presents differing patterns in different countries, making a single recommendation for all situations unwise. The BCG program chosen should be based on the epidemiological situation in each country. The authors conclude that BCG vaccination, together with chemoprophylaxis and chemotherapy, can play an important role in controlling tuberculosis, which still constitutes 1 of the major world health problems. (summaries in SPA, POR, ARA)