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Pandemic influenza A H1N1: Vaccination campaigns protect the most vulnerable populations in Togo. Photo and caption.
Arlington, Virginia, JSI, DELIVER, 2010 Dec.  p.During two countrywide vaccination campaigns, Togo's MOH immunized 10 percent of its most at-risk populations. Togo is one of 40 countries conducting a national H1N1 immunization campaign in collaboration with WHO and the USAID | DELIVER PROJECT.
Measles immunisation before the age of nine months? Position statement by the Expanded Programme on Immunisation of the World Health Organisation.
Lancet. 1988 Dec 10; 2(8624):1356-7.In developing countries, where measles in young infants results in high mortality, it would be advantageous to immunize children at 6 months. However, the efficacy of standard-dose vaccines at 6 months is low, and a second dose at 9 months is required, which all too often is not given. At a meeting in Washington, D.C., sponsored by the World Health Organization, the US Agency for International Development, and the US National Institutes of Health. Comparative data were presented for the higher-than-standard dose Edmonston-Zagreb vaccine, the AIK-C vaccine, and Schwarz vaccines given earlier than 9 months, with standard-dose Schwarz measles vaccine given at 9 months. The data were reviewed by the Expanded Program on Immunization and the Global Advisory Group, which concluded that higher-than-standard dose vaccines for use before 9 months needed further evaluation and countries should continue to administer standard vaccines after 9 months except among high-risk populations, where standard dose vaccines should be given at 6 months and the children reimmunized after 9 months.
Discussions and briefing at the WHO Global Programme for Vaccines and Immunization, December 16, 1994.
Arlington, Virginia, Partnership for Child Health Care, 1994. , 10,  p. (BASICS Trip Report; BASICS Technical Directive: 000 NS 01 001; USAID Contract No. HRN-6006-C-00-3031-00)A staff member from BASICS (Basic Support for Institutionalizing Child Survival) spent December 16, 1994, with staff of the World Health Organization (WHO) in Geneva to 1) introduce BASICS' Expanded Program on Immunization (EPI) strategy; 2) present BASICS' research and development priorities for the second year of the project; 3) review the countries currently receiving BASICS EPI technical assistance and those which may receive assistance in the future; and 4) discuss coordination with WHO of some of the upcoming opportunities in individual countries. Ways in which WHO can access BASICS resources and help open doors at country level for BASICS technical assistance were stressed. This trip report contains notes of conversations with WHO staff about these issues as well as reminders of follow-up actions needed. The appendices provide details of the WHO group briefing, the research and development priorities of the BASICS working group on sustainability of immunization programs, a list of persons contacted, the structure of the provisional staff for the Global Programme for Vaccines and Immunization (GPV), a description of the structure of the GPV, and the GPV technical briefing schedule.
[Unpublished] 1989. , 16,  p. (USAID Contract No. DPE-5927-C-00-5068-00)The Ministry of Public Health (MSP) and external agencies participating in Ecuador's Expanded Program on Immunization (EPI) decided in 1987 that a field-oriented supervisor was needed to help improve the implementation of immunization service delivery at operational levels. Dr. Jose Litardo was therefore retained as EPI Field Coordinator to offer technical support including 2 short-term visits annually from REACH headquarters. The 1st visit was January 11-22, 1989, during which detailed discussions were had with USAID, the Ministry of Public Health (MSP), PAHO, and UNICEF staff; a 3-day field trip within Cotopaxi Province also took place so that EPI supervisory techniques could be demonstrated, strengths and weaknesses in the EPI identified, and recommendations formulated. It was found that the MSP needs technical, managerial, administrative, and logistic support for its EPI at provincial and canton health area levels as it continues to extend its regionalization of health services. More personnel like the REACH EPI Field Coordinator will be needed. It was also found that the program has been slack in meeting routine demand for immunization services; the prevention of neonatal tetanus has been overlooked relative to other EPI target diseases; many norms in use Ecuador do not reflect internationally accepted WHO EPI policies; third doses of vaccine are not completed before age 12 months in many areas; and training in the management and supervision of the cold chain is needed. REACH supports the MSP's decision to assign Litardo to Esmeraldas in 1989. Recommendations are provided on regionalization, delivery strategies, EPI norms, monitoring immunization coverage, supervision, the cold chain, and research.
Arlington, Virginia, John Snow, Inc., Resources for Child Health Project (REACH), 1989 Apr. , 102 p. (USAID Contract No. DPE-5927-C-00-5068-00)A review of 28 reports from the cost-effectiveness literature published between 1979 and 1987 which evaluated the Expanded Program on Immunization (EPI) was undertaken by the Resources for Child Health Project (REACH) for the Program and Policy Coordination Bureau of the USAID as part of the Immunization Sustainability Study. The objectives were to assess the quality of cost-effectiveness studies of the EPI and to determine whether these data were a sufficient basis for generalization relationships between program costs and coverage levels in the future. In 1985, the Pan American Health Organization (PAHO) committed itself to the eradication of polio virus from the region by 1990. PAHO's preliminary analysis for 19 countries showed that more than $450 million was committed to the Plans of Action was 85% financed by government resources. By 1988, worldwide immunization coverage reported for the third doses of DPT and polio vaccine has surpassed the 50% level in both developing and developed countries. UNICEF was accelerating the EPI to achieve Universal Childhood Immunization (UCI). USAID funding for immunization increased from $30 million in 1985 to $51 million in 1988, and the agency strove for universal immunization by 1990. USAID also funded efforts made by PAHO, the Rotary International, and UNICEF toward global eradication of polio and universal childhood immunization by 1990. The average cost per fully immunized child was $13 which was within the specified range of $5-$15 per child presented at the Bellagio Conference in 1984. Routine services through fixed facilities cost $11.74 per fully immunized child. Immunization campaigns cost $15.62 per fully immunized child. Immunization programs in Africa have lower average costs than those in Asia between $12.26 and $16.41 for all strategies. For routing services through fixed facilities, the proportion of government contribution was 55% of total; it diminished to 40% for campaign strategies. International organizations and donor agencies covered EPI costs (such as vaccines, syringes, cold chain equipment, vehicles, and local training costs). The Mauritania national campaign had a cost-effectiveness ratio of almost 1/2 that of the campaigns in Cameroon and Senegal because of a smaller urban target population, while greater numbers of doses of vaccine were administered in Senegal than in Mauritania. A cost- effectiveness study protocol is needed to standardize basic costing and effectiveness terminology and methods and to address the needs of program managers and policy makers.
INFECTION CONTROL. 1984 Nov; 5(11):538-41.In 1978 the Ministry of Health and Social Welfare (MHSW) of Liberia launched the Expanded Program on Immunization (EPI) with the 5-year objective of establishing an 80% reduction in child mortality and morbidity from measles, polio, diphtheria, neonatal tetanus, pertussis, and tuberculosis. The program at first adopted a strategy of using 15 mobile units in 11 operational zones to deliver vaccinations throughout the country. However, by 1980, despite support from the Baptist World Alliance, the UN International Children's Emergency Fund (UNICEF), and the World Health Organization (WHO), it became evident that the mobile strategy was neither economically feasible nor practical. Therefore, with support from the US Agency for International Development (USAID), the EPI shifted to a strategy of integrating immunization activities into the existing network of state health facilities. After 5 years, in 1982, the Program was evaluated by a team from the MHSW, WHO, USAID, and the Centers for Disease Control. The evaluating team felt that the EPI's strategy was good, but its goals were not being achieved due to deficiencies in funding, clinic supervision, and rural community outreach, as well as shortages of kerosene and spare parts needs to keep the essential refrigerators in operating condition. Measles remains endemic; in the capital, Monrovia, only 9% of the children have been vaccinated against it. Immunization coverage is particularly low in the capital the countries. Other reasons for low vaccination coverage in Liberia are lack of community awareness of existing facilities and the importance of vaccination and lack of coordination at the community level to use the existing facilities efficiently. International assistance is still needed, especially to develop heat-stable vaccines, so that maintenance of refrigerators will not be necessary.
In: Protecting the World's Children, "Bellagio II" at Cartegena, Colombia, October 1985, prepared by The Task Force for Child Survival. Decatur, Georgia, The Task Force for Child Survival, 1986 Mar. 61-74.The Expanded Programme on Immunization (EPI) was initiated in accordance with a 1974 World Health Assembly resolution. The EPI was endorsed for the Americas by the Directing Council of the Pan American Health Organization (PAHO) in 1977. Since its inception in 1977, the EPI program in the Americas has made considerable progress. More than 15,000 health workers have been trained in EPI workshops. A cold chain regional focal point in Cali, Columbia, has trained over 150 technicians in cold chain equipment, maintenance, and repair. Schools of public health in the region have been actively involved in EPI training. Most countries have made notable strides in improving and expanding the equipment and proceedures used in the cold chain to assure the potency of vaccines. PAHO created the EPI Revolving Fund, which has assisted countries in the region with vaccine purchases worth more than US$19 million. This fund has contributed to improved vaccine quality and the ready availability of vaccines at the country level. Since November, 1980, PAHO has collaborated with other organizations that support immunization activities, including UNICEF, USAID, Rotary International, and the Bellagio Task Force for Child Survival. An additional effort in priority countries specifically directed at polio can lead to the interruption of indigenous poliovirus transmission in the Western Hemisphere in a short period of time.
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.