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Report of the Expanded Programme on Immunization Global Advisory Group Meeting, 20-23 October 1980, Geneva.
[Unpublished] 1980. 39 p. (EPI/GEN/80/1)This report of the Expanded Program on Immunization (EPI) Global Advisory Group Meeting, held during October 1980 in Geneva,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.
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.
The global eradication of smallpox. Final report of the Global Commission for the Certification of Smallpox Eradication, Geneva, December 1979.
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.
[Washington, D.C.], PAHO, . 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.
[Washington, D.C] PAHO, .  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.
Report of the first meeting of the Scientific Working Group on Viral Diarrhoeas: microbiology, epidemiology, immunology, and vaccine development, Geneva, 1980.
Geneva, Switzerland, WHO, 1980. 11 p.The main function of the Scientific Working Group was to review existing knowledge, designate areas where research was needed, recommended approaches for such research; and prepare a research plan. The Group's five year work plan for research is described, consisting of 3 priority topics: investigations related to viral diarrheas in general, studies of rotavirus diarrhea (recognized by the Group as the most important public health problem among the viral diarrheas at present), and research to determine the possible role as a cause of diarrhea of other viral agents (Norwalk and Norwalk-like agents, adenoviruses, calcivirus, coronavirus, axtrovirus, and other small round viruses). Needed epidemiological studies, clinical studies, and studies of disease resistance and vaccine development are identified. Identification of institutions to undertake research was discussed; priority was given to locating institutions and individuals within the developing world, or those in developed countries which work closely with developing world groups. An application form was reviewed and approved, and some general principles established. A list of participants in the meeting, and the 1st report of the Rotavirus reagents subgroup are appended.
[Unpublished] 1980. 10 p.This paper briefly reviews the development of the highly effective and universally applicable ORS (oral rehydration solution) recommended by WHO, and tested world wide during the past decade. ORS is prepared by adding appropriate amounts of glucose, sodium bicarbonate, and potassium chloride to drinking water to give the optimum concentration for intestinal absorption of electrolytes and water to replace acute diarrhoeal losses. Many studies conducted in developing countries attest to the enormous success of programs extending the delivery of oral rehydration therapy to the village and to the household level, thus significantly reducing infant mortality. The paper also describes the physiological basis of oral rehydration, and its nutritional benefits.
Resistance of vectors of disease to pesticides: fifth report of the WHO Expert Committee on Vector Biology and Control.
World Health Organization Technical Report Series. 1980; (655):1-83.The resistance of vectors (the term includes primary and intermediate vertebrate and invertebrate hosts and animal reservoirs of human and animal diseases) of disease to pesticides is a major problem faced by WHO member states in the control of vectorborne diseases. Since the meeting of the WHO Expert Committee on Insecticides in 1975, resistance has continued to increase and to affect disease control programs in many countries. The appearance of multiresistance in several important vectors has been the most significant development since the 1975 meeting. The sandfly Phlebotomus papatasi in Bihar, India has been found to be resistant to DDT, leaving the tsetse fly the only important vector species in which resistance has not been reported. This book discusses 1) pesticide resistance in arthropod vectors, malaria vectors, vectors of other diseases and disease reservoirs (rodents); 2) present status of research on resistance of vectors to pesticides, including the biochemistry and genetics of resistance; 3) measures to counteract resistance; 4) detection and monitoring of vector resistance to pesticides; 5) disseminatin of information and training; and 6) recommendations for future research and courses of action.
Geneva, Switzerland, WHO, 1980. 25 p.Basic guidelines are presented for treatment of acute diarrhea in patients of different age and nutritional status, with emphasis on oral rehydration therapy for infants. The manual is intended for physicians, senior health workers and treatment facility staff and is designed for easy adaptation to local needs and situations. Definitions of diarrhea and dehydration and principles of patient assessment including needed medical history and signs and symptoms of mild, moderate and severe dehydration are spelled out. Patient management including fluid therapy and maintenance of nutrition is discussed for infants, older children and adults with differing severity of illness. The amount and rate of oral rehydration salt administration, other medicines that should and should not be used for different types of diarrheas, and associated problems and complications including malnutrition, fever, and convulsions are also discussed, as a measures for diarrhea prevention. The composition of oral rehydration salts and different solutions for intravenous infusion are discussed.
Guidelines for the trainers of community health workers on the treatment and prevention of acute diarrhoea.
Geneva, Switzerland, WHO, 1980. 29 p.Guidelines to help trainers of community health workers in teaching simple methods and procedures for treatment of acute diarrheal disease are presented. The material is divided into 3 sections: a description of the problem of diarrhea including its causes and dangers; a discussion of treatment including patient assessment, treatment plans for infants and young children, methods of feeding children with diarrhea, treatment plans for older children and adults, medicines for diarrhea, and reporting of cases; and a discussion of prevention of diarrhea covering food and feeding practices, water, and hygiene. The important topics recommended for discussion during training and a list of essential information are included in each section. The information in the guidelines is general and requires adaptation to local cultures and to the particular role of the community health worker in the national health program.
Geneva, Switzerland, WHO, 1980. 58 p.Guidelines suitable for adaptation to local conditions in different countries are designed to assist national authorities in establishing facilities for the production of packets of oral rehydration salts (ORS) of pharmaceutical quality for use in prevention and treatment of clinical dehydration. The composition of oral rehydration salts, procedures for estimating production needs and possibilities, a 6-room facility recommended for ORS manufacture, costs and specification for raw materials including glucose, sodium chloride, sodium bicarbonate, potassium chloride, aerosil, and packaging material, and suggestions for labelling are set forth. Itemized costing and power requirements of necessary and optional production and quality control equipment are listed, and some general considerations concerning equipment are discussed. A series of appendices include a checklist for different aspects of manufacture, example specification for ordering and testing finished packets of ORS, a discussion of good practices in the manufacture and quality control of drugs, examples of order specifications for ORS components, and test procedures for quality control of components and finished ORS packets.
Geneva, Switzerland, WHO, 1980. 14 p.This manual was designed to help national health workers, particularly managers of diarrheal disease control programs, to implement cholera control activities within the context of national programs. Recent knowledge of the bacteriology and epidemiology of cholera is presented, followed by a discussion of necessary preparations for cholera control. Case fatality rates of as high as 50% have been reported in unprepared communities, but the rate diminishes to under 3% when proper treatment becomes available. Preparations for cholera control including formation of national epidemic control committee, surveillance activities, health education activities, training in clinical management of acute diarrhea, laboratory services, establishment of mobile control teams, and logistics are described. The epidemic phase of a cholera outbreak requires intensification of ongoing diarrheal disease control activities. Components of the epidemic phase program including early case finding, establishing treatment centers, treatment, epidemiological investigation, laboratory support, control and prevention are discussed. Basic supplies for a mobile control team are listed.
Report of the First Meeting of the Scientific Working Group on Bacterial Enteric Infections: Microbiology, Epidemiology, Immunology, and Vaccine Development, Geneva, April 1980.
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.
Geneva, Switzerland, WHO, 1980. 28 p.Presented in this module is a training exercise based on a fictitious developing nation, and in order to use this module successfully reference should be made to the 1st module in the series which provides the framework-- "Fictitia" [Training Module], (SI)802686. In this module a delivery system is defined as the manner in which personnel, facilities, equipment and supplies could be organized for the purpose of delivering health care to a specific population. Attention is directed to how to select the delivery systems through which Control of Diarrheal Diseases (CDD) activities will be integrated with other national programs and health activities. The 3 basic steps in selecting delivery systems are: describing existing systems which could deliver primary health care services; selecting from current and potential providers of primary health care those appropriate to deliver CDD services; and assigning CDD responsibilities to selected providers. Each step is described in detail in this module, and it is shown how each step could be performed in a CDD program.
[Geneva, WHO, 1980.] 35 p.Presented in this module is a training exercise based on a fictitious developing nation, and in order to use this module successfully reference should be made to the 1st module in the series which provides the framework -- "Fictitia" [Training Module], (SI)802686. It is imperative that a program manager in a program for Control of Diarrheal Diseases (CDD) be continually alert in order to recognize the existence of problems which might prevent CDD targets, sub-targets, and desired outputs from being realized. Focus in this module is on identifying specific performance problems in a CDD program, what the reasons for these problems might be, and what can be done to resolve them. 4 basic steps are practiced in this module in the problem solving process: identifying a performance problem; describing the performance problem; identifying possible causes of the performance problem; and identifying reasonable solutions to the performance problem. The exercise relates to the CDD program that has been in progress in the Coastal Region of Fictitia for about 1 year.
[Geneva, WHO, 1980.] 43 p.Presented in this module is a training exercise based on a fictitious developing nation, and in order to use this module successfully reference should be made to the 1st module in the series which provides the framework, "Fictitia" [Training Module], (SI)802686. Focus in this module is on establishing objectives and targets for a national program for control of diarrheal disease. Objectives and targets are the morbidity and mortality reduction goals which are identified. A long-term effort is necessary, and committed national leadership and budgeting support are essential to sustained progress in an integrated program of diarrheal disease control. In this module, consideration will be given to national diarrheal disease control objectives, and the emphasis to be placed on each of the recommended control strategies in Fictitia. A target worksheet and data on Fictitia will then be used to write targets for reduction of diarrheal mortality in children under age 5 in Fictitia. This module should improve one's ability to recognize the benefits, constraints, and requirements involved in using the recommended diarrheal control strategies in one's own country and to write medium-term and long-term national targets for reduction of mortality due to diarrhea in children under age 5.
[Geneva, WHO, 1980]. 15 p.This training module, the first in a series predicated upon demographic data presented in the next module in this series entitled "Fictitia" PIP/802686, a wholly fictitious developing nation, is designed to introduce the issue of diarrheal diseases as a global public health issue. In the developing world, diarrheal disease is one of the most important causes of morbidity and mortality among children under 5 years old. This course, presented in modules, is designed to help improve the skills and knowledge of health care delivery managers of national programs for diarrheal disease control. The introduction explains the course's organization and course operations. It also provides a glossary of terms used in these training materials and a list of abbreviations applicable to the subsequent teaching materials as well. This series of training modules was designed by WHO.
[Geneva, WHO, 1980]. 54 p.In this training module, 1 in a series of such modules published by WHO, the student is asked to practice the following selected tasks involved in evaluation of a national program for control of diarrheal diseases. 1) Review a data collection form for clarity, simplicity, and completeness. 2) Plan collection of data for evaluation of a specific subtarget. 3) Prepare a chart showing numbers of diarrhea cases, and identify disease trends. 4) Calculate and compare annual mortality rates in an area. 5) Explore reasons for failure to achieve an expected mortality reduction. 6) Estimate the amount of money saved by providing vs. hospital therapy. This workbook can be used in conjunction with another in this WHO series on the teaching of programs for control of diarrheal diseases in developing countries, where they are a major cause of morbidity and mortality among children under 5, "Fictitia PIP/802686 which provides fictitious data on a made up developing country to use in solving workbook problems during this course.
[Geneva, WHO, 1980]. 45 p.As part of a series of WHO-designed training modules on developing a national program (in a developing nation) for the control of diarrheal diseases, this volume teaches how to determine logistical problems of supply and distribution of therapeutic modules for control of diarrheal disease. In this module, the student is expected to learn how to determine the quantity of oral rehydration salts (ORS) necessary in Fictitia, a wholly made up country, data on which is published in another module in this series called "Fictitia" PIP/802686, to recommend a distribution system for Fictitia, to determine the number of ORS packets the program manager needs to stock for proper inventory in Fictitia, to specify a schedule for reordering ORS packets in Fictitia, to determine the cost of local production of ORS in Fictitia, and to recommend whether Fictitia should produce its own ORS by target date 1986 or import the ORS the country needs.
[Geneva, WHO, 1980]. 123 p.This course facilitator, or teacher, guide is part of a series of modules which comprise a training course for health care deliverers in developing countries designed to teach the skills necessary to implement a program for control of diarrheal diseases on a national scale. In this course, each participant is provided with a set of booklets called modules that serve as the primary subject matter resource. The materials are designed to assist the participant in developing specific skills. The participant in this course is encouraged to work at his or her own pace within the time constraints imposed by the course length. The participant is expected to discuss any problems or questions with the course facilitor as they arise, and this teacher's module is designed to help the course facilitor provide immediate feedback of completed course work. WHO designed this training program, and all of the modules which comprise the student material are in POPLINE.
[Geneva, WHO, 1980]. 20 p.As part of the WHO series of training modules on programs for the control of diarrheal disease in developing nations, this module teaches how to select the priority health problems in children under age 5 for the country of Fictitia, a wholly made up collection of data on demographics and population characteristics which is presented in another, separate cover, training module in this series, "Fictitia" PIP/802686. The skills of priority selection gleaned from using this workbook in conjunction with fictitious data on a theoretical developing country called Fictitia should help health care providers in real developing nations learn the skills to allow them to select the priority health problems in their own country. Theoretical problems are put forth for users of these modules, designed by WHO, to solve (e.g., assess the incidence of a given health problem based on the data in "Fictitia" for a given year, or assess mortality from a health problem based on data for the theoretical developing country of Fictitia).
[Geneva, WHO, 1980]. 65 p.This WHO publication, one in a series which comprise a complete course on how to set up a diarrheal disease control program in a developing nation, is designed to teach the skills to health care providers from developing countries required to isolate specific sub-targets during different phases of implementation of a theoretical national program. This and its companion volumes which stress various aspects of designing a national diarrheal disease control program may be used in conjunction with a volume that publishes fictitious data on demographic and population characteristics in a fictitious country, "Fictitia" PIP/802686. This module on subtargeting has the student consider the plan for phasing of a national program for control of diarrheal diseases in the theoretical developing country of Fictitia, write subtargets for a region of the initial phases of such a national program, determine whether or not achievement of regional or coverage subtargets throughout Fictitia is likely to lead to achievement of the medium-term mortality reduction, and specify the major activities necessary to achieve 1 of the regional subtargets.
[Geneva, WHO, 1980]. 19 p.As part of a series of training modules which form a course, the purpose of which is to train health care practitioners and deliverers how to effectively set up an in-country program for control of diarrheal disease, this module presents ficticious data (demographics and population characteristics) about a made-up developing nation, Fictitia. Further modules in this series train users how to order priorities in a diarrheal control program, how to focus on targets and sub-targets in the population and delivery system, how to design an effectively administered diarrheal disease control program, and how to evaluate any such program once implemented in an actual developing nation. Since diarrheal disease is 1 of the largest causes of morbidity and mortality among children under 5 in developing nations of this world, WHO created these training manuals as exercises, which would provide skills, upon course completion, applicable to an actual developing nation on earth.
Epidemiology and control of schistosomiasis: report of a WHO Expert Committee, Geneva, 6-10 November, 1978.
Geneva, Switzerland, WHO, 1980. (WHO Technical Report Series No. 643)The World Health Organization (WHO) Expert Committee on Epidemiology and Control of Schistosomiasis met in Switzerland in November 1978 and dealt with epidemiology (the parasite, the snail intermediate host, human infection), control (review of progress in selected national control programs, control tools and techniques, factors influencing the choice of control methods in schistosomiasis, and evaluation of control), training courses in parasitology and in epidemiology, the feasibility of control, the strategy of control, and control policies in the future. Although reliable and effective schistosomiasis control measures have become available, the most appropriate combinations of these measures still need to be worked out. Both disease control in the human population and transmission control of the biological cycle are essential to the concept of total control of schistosomiasis. Drug treatment will have an increasingly significant role in disease and transmission control, but there is also a need for operational research in order to define the best ways of using the available drugs. The cost of control at this time will make it difficult for the poorer endemic countries to have effective programs within the constraints of their health budgets, meaning that less expensive methods of control are necessary. Programs that have depended exclusively on chemotherapy experienced problems after some years, and it is important to encourage the use of other methods in programs using chemotherapy on a large scale.
Geneva, Switzerland, WHO, 1980. (WHO Technical Report Series No. 645)In this report of the World Health Organization (WHO) Expert Committee on Specifications for Pharmaceutical Preparation, focus is on the following: 1) quality assurance in pharmaceutical supply systems; 2) revisions of the International Pharmacopoeia (methods of drug analysis, monographs for pharmaceutical raw materials, monographs for dosage forms, monographs for pharmaceutical aids); 3) international chemical reference substances for pharmaceuticals (reports from the WHO Collaborating Center, certificates, secondary reference substances, international cooperation, revision of guidelines); 4) quality requirements for oral dosage forms (tests for solid oral dosage forms, tests for liquid oral dosage forms, guidelines for in-process control of the manufature of some types of dosage forms); and 5) basic tests (basic tests for pharmaceutical substances, simple tests for the absence of gross degradation, basic tests for tablets and capsules, publication of basic tests). The Committee concluded that the term "quality assessment" was appropriate to the activities of governmental agencies who have been authorized to assess by inspection, surveillance and other means how closely manufacturers and distributers comply with drug quality requirements. Manufacturers are considered fully responsible for the quality of their products.