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  1. 1

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    [Unpublished] 1980. 39 p. (EPI/GEN/80/1)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

    Vaccination against tuberculosis. Report of an ICMR/WHO Scientific Group.

    World Health Organization [WHO]. Scientific Group on Vaccines Against Tuberculosis


    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.
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  3. 3

    The global eradication of smallpox. Final report of the Global Commission for the Certification of Smallpox Eradication, Geneva, December 1979.

    World Health Organization [WHO]. Global Commission for the Certification of Smallpox Eradication

    Geneva, Switzerland, WHO, 1980. 122 p. (History of International Public Health No. 4)

    The Global Commission for the Certification of Smallpox Eradication met in December 1978 to review the program in detail and to advise on subsequent activities and met again in December 1979 to assess progress and to make the final recommendations that are presented in this report. Additionally, the report contains a summary account of the history of smallpox, the clinical, epidemiological, and virological features of the disease, the efforts to control and eradicate smallpox prior to 1966, and an account of the intensified program during the 1967-79 period. The report describes the procedures used for the certification of eradication along with the findings of 21 different international commissions that visited and reviewed programs in 61 countries. These findings provide the basis for the Commission's conclusion that the global eradication of smallpox has been achieved. The Commission also concluded that there is no evidence that smallpox will return as an endemic disease. The overall development and coordination of the intensified program were carried out by a smallpox unit established at the World Health Organization (WHO) headquarters in Geneva, which worked closely with WHO staff at regional offices and, through them, with national staff and WHO advisers at the country level. Earlier programs had been based on a mass vaccination strategy. The intensified campaign called for programs designed to vaccinate at least 80% of the population within a 2-3 year period. During this time, reporting systems and surveillance activities were to be developed that would permit detection and elimination of the remaining foci of the disease. Support was sought and obtained from many different governments and agencies. The progression of the eradication program can be divided into 3 phases: the period between 1967-72 when eradication was achieved in most African countries, Indonesia, and South America; the 1973-75 period when major efforts focused on the countries of the Indian subcontinent; and the 1975-77 period when the goal of eradication was realized in the Horn of Africa. Global Commission recommendations for WHO policy in the post-eradication era include: the discontinuation of smallpox vaccination; continuing surveillance of monkey pox in West and Central Africa; supervision of the stocks and use of variola virus in laboratories; a policy of insurance against the return of the disease that includes thorough investigation of reports of suspected smallpox; the maintenance of an international reserve of freeze-dried vaccine under WHO control; and measures designed to ensure that laboratory and epidemiological expertise in human poxvirus infections should not be dissipated.
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  4. 4

    Planning immunization activities.

    Pan American Health Organization [PAHO]. Expanded Program on Immunization [EPI]; Pan American Health Organization [PAHO]. Expanded Program for Textbooks and Instructional Materials

    [Washington, D.C.], PAHO, [1980]. 36 p. (Expanded Program on Immunization (EPI) Workshop Module IV)

    Upon completion of this module devoted to planning immunization activities, the participant will be able to explain the elements involved in planning immunization activities. Specific objectives include: to choose priorities among the Expanded Program on Immunization (EPI) diseases and vaccines; to choose the priority population groups for EPI: to gather essential information about the community to be provided with immunization services; to be able to make an inventory of resources needed in immunizations; to apply the technique of problem analysis and solution to the immunization program; to define different tactics for immunization activities; to be able to write quantitative objectives; and to estimate vaccine needs for a given population. The module covers: priority among geographic areas and people; location of health facilities in relation to the population to be served; problem analysis and solution; selection of immunization tactics; scheduling vaccination activities; setting quantitative objectives; and planning vaccine distribution.
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  5. 5

    EPI evaluation. Unit 1: evaluation methods.

    Pan American Health Organization [PAHO]. Expanded Program on Immunization [EPI]; Pan American Health Organization [PAHO]. Expanded Program for Textbooks and Instructional Materials

    [Washington, D.C] PAHO, [1980]. [51] p. (Expanded Program on Immunization (EPI) Workshop. Module V)

    At the end of this module, the participant will be able to analyze the various available methods to evaluate immunization activities. Specific objectives include: to use the success or failure in accomplishing program objectives to evaluate Expanded Program on Immunization (EPI) performance; to recognize the reduction of cases and deaths caused by the EPI diseases as the ultimate evaluation of the program; to define vaccination coverage; to state the different sources of data on vaccination coverage (including the sample survey); to explain the evaluation of "key" inputs; to explain how evaluation is used in the management of immunization activities; and to explain how supervision contributes to program evaluation. The purpose of evaluation is to manage the EPI activities better. When new problems are identified through evaluation, solutions to these problems are necessary. Ideally, the process of problem identification, problem solution, performance, and evaluation is continuous and leads to increasingly better performance.
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  6. 6

    Report of the First Meeting of the Scientific Working Group on Bacterial Enteric Infections: Microbiology, Epidemiology, Immunology, and Vaccine Development, Geneva, April 1980.

    World Health Organization [WHO]. Programme for Control of Diarrhoeal Diseases

    Geneva, Switzerland, WHO, 1980. 17 p.

    The group developed a five year research plan (1980-84). Topics were given priority based on the following group-established criteria: 1) the extent of the problem to be studied; 2) the chance of its early success given the limited funds available; and 3) the availability of good research workers with an interest in the problem. The epidemiology and microbiology of Vibrio cholerae 01 and Enterotoxigenic Escherichia coli (ETEC) are given first priority for study, as are immunology and vaccine development against cholera and ETEC diarrhoea. The immunology study will involve: 1) identification of protective antigens, 2) tests for antibody measurement and 3) measurement of acquired immunity. Methods of stimulating mucosal immunity are given first priority, as is the testing of existing candidate cholera vaccines such as B-subunit cholera vaccine and living vaccines made from non-toxigenic V. cholerae. Other organisms which will be studied are Campylobaster jejuni (which can account for up to 15% of acute diarrhoea cases in some settings), Salmonella, (including S. typhi), Shigella and Yersinia enterocolitica. Once there is a better understanding of the modes of transmission of the bacterial enteric pathogens, a study of specific cost effective methods of interrupting their transmission through environmental intervention is suggested, with emphasis on modifications in water supply and water usage, defecation practices, and personal and domestic hygiene. Identification of institutions to undertake research, and funding distribution, were also considered.
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  7. 7

    Smallpox eradication.

    Henderson DA

    PUBLIC HEALTH REPORTS. 1980 Sep-Oct; 95(5):422-6.

    The implications of the eradication of smallpox in the context of epidemiology are presented. Eradication of disease has been conceived since the 1st smallpox vaccination was developed in the 18th century. Since then, attempts to eradicate yellow fever, malaria, yaws and smallpox have been instituted. Most public health professionals have been rightfully skeptical. Indeed, the success with smallpox was fortuitous and achieved only by a narrow margin. It is unlikely that any other disease will be eradicated, lacking the perfect epidemiological characteristics and affordable technology. The key to success with smallpox was the principle of surveillance. This concept has a vigorous developmental history in the discipline of epidemiology, derived from the work of Langmuir and Farr. It involves meticulous data collection, analysis, appropriate action and evaluation. In the case of smallpox, only these techniques permitted the key observations that smallpox vaccination was remarkably durable, and that effective reporting was fundamental for success. The currently popular goal of health for all, through horizontal programs, is contrary to the methods of epidemiology because its objective is vague and meaningless, no specific management structure is envisioned, and no system of surveillance and assessment is in place.
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  8. 8

    [Smallpox eradication] Certification de l'eradication de la variole

    Weekly Epidemiological Record / Releve Epidemiologique Hebdomadaire. 1980 Feb 1; 55(5):33-4.

    At its final meeting in December 1979, the Global Commission for the Certification of Smallpox Eradication concluded that smallpox eradication has been achieved on a worldwide basis and there is no evidence that smallpox will return as an endemic disease. The 65th session of the WHO's Executive Board, held on January 25, 1980, endorsed these conclusions and made 19 recommendations covering the areas of vaccination policy, reserve stocks of vaccine, investigation of suspected smallpox cases, laboratories retaining variola virus stocks, human monkeypox, laboratory investigations, documentation of the smallpox eradication program, and WHO headquarters staff. Sufficient freeze-dried smallpox vaccine to vaccinate 200 million people will be maintained by WHO in refrigerated depots in 2 countries. WHO will ensure that appropriate publications are produced describing smallpox and its eradication, with special emphasis on the principles and methods that are applicable to other programs.
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  9. 9

    BCG vaccines: tuberculosis experts to discuss lack of protection.

    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.
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  10. 10

    Health and development: a selection of lectures and addresses.

    Quenum CA

    Brazzaville, Congo, World Health Organization, Regional Office for Africa, 1980. 86 p. (Health Development in Africa 1)

    Primary health care has been accepted by the 44 Member States and Territories of the African Region of the World Health Organization (WHO); the Health Charter for 1975-2000 was adopted in 1974 with its humanistic approach oriented to satisfying basic needs. Genuine technical cooperation between Member States is essential for health development and can be achieved on the regional level. By 1990 the following steps should be taken: 1) vaccination of all infants under 1 year against measles, pertussis, tetanus, poliomyelitis, diphtheria and tuberculosis, 2) supply of drinking water to all communities and 3) waging a war on hunger. Health development is seen as a social development policy requiring combined efforts in the fields of education, agriculture, transport, planning, economics, and finance as well as a national strategy which WHO can help to define. A new international economic order must aim at meeting basic needs of the poorest in the population and includes health needs. Basic health services must provide primary health care which includes preventive and curative care, promotional and rehabilitative care, maternal and child health, sanitation, health education, and systematic immunization. Secondary care includes outpatient services with specialized teams; tertiary care provides highly specialized services. These services must be geographically, financially, and culturally accessible to the community. Communication between health workers and community leaders is fundamental in setting up those services and group dynamics can be utilized in promoting change. WHO's 4 health priorities in Africa are: 1) epidemiological surveillance, 2) promotion of environmental health, 3) integrated development of health manpower and services, and 4) health development research promotion. The components of Africa's health care program are: 1) community education, 2) promotion of food supply and nutrition, 3) safe water and sanitation, 4) maternal and child health, 5) immunization, 6) disease prevention, 7) treatment of injuries and diseases and 8) provision of essential drugs. Proper training of personnel is crucial for the success of these steps, along with effective personnel management.
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  11. 11

    Vaccinating all the children.

    Hanlon J

    People. 1980; 7(4):24-5.

    Lack of immunization from common childhood diseases account for the high infant mortality of many developing countries. A major problem in developing areas is the lack of a cheap method of transporting and delivering vaccines. Vaccines must be kept cold or they perish quickly. Vaccinating teams in developing countries have to make do with inadequate equipment such as picnic hampers and vacuum flasks. The WHO's Expanded Programme on Immunization aims to provide vaccination services for every child by 1990, but this target year is unrealistic unless adequate equipment and vaccines can be produced. To solve the problem of reliable refrigeration in the rural areas, multinational companies and research organizations in the developed world are developing kerosene and bottled gas refrigeration, and even solar-powered refrigeration. WHO is also encouraging and assisting countries to manufacture their own cold chain equipment so that they will be less dependent on developed countries for survival of their vaccination programs, and routine repairs and replacements will be easier. Cost appears to be the major barrier to the fulfillment of WHO's objective by 1990. The developing countries do not have the money for the vaccination programs, and it is not known whether the rich nations will provide money to save the lives of millions of children.
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