Are we doing enough? Evaluation of the Polio Eradication Initiative in a district of Pakistan's Punjab province: a LQAS study

<p>Abstract</p> <p>Background</p> <p>The success of the Global Polio Eradication Initiative was remarkable, but four countries - Afghanistan, Pakistan, India and Nigeria - never interrupted polio transmission. Pakistan reportedly achieved all milestones except interrupting virus transmission. The aim of the study was to establish valid and reliable estimate for: routine oral polio vaccine (OPV) coverage, logistics management and the quality of monitoring systems in health facilities, NIDs OPV coverage, the quality of NIDs service delivery in static centers and mobile teams, and to ultimately provide scientific evidence for tailoring future interventions.</p> <p>Methods</p> <p>A cross-sectional study using lot quality assessment sampling was conducted in the District Nankana Sahib of Pakistan's Punjab province. Twenty primary health centers and their catchment areas were selected randomly as <it>'lots'</it>. The study involved the evaluation of 1080 children aged 12-23 months for routine OPV coverage, 20 health centers for logistics management and quality of monitoring systems, 420 households for NIDs OPV coverage, 20 static centers and 20 mobile teams for quality of NIDs service delivery. Study instruments were designed according to WHO guidelines.</p> <p>Results</p> <p>Five out of twenty lots were rejected for unacceptably low routine immunization coverage. The validity of coverage was questionable to extent that all lots were rejected. Among the 54.1% who were able to present immunization cards, only 74.0% had valid immunization. Routine coverage was significantly associated with card availability and socioeconomic factors. The main reasons for routine immunization failure were absence of a vaccinator and unawareness of need for immunization. Health workers (96.9%) were a major source of information. All of the 20 lots were rejected for poor compliance in logistics management and quality of monitoring systems. Mean compliance score and compliance percentage for logistics management were 5.4 ± 2.0 (scale 0-9) and 59.4% while those for quality of monitoring systems were 3.3 ± 1.2 (scale 0-6) and 54.2%. The 15 out of 20 lots were rejected for unacceptably low NIDs coverage by finger-mark. All of the 20 lots were rejected for poor NIDs service delivery (mean compliance score = 11.7 ± 2.1 [scale 0-16]; compliance percentage = 72.8%).</p> <p>Conclusion</p> <p>Low coverage, both routine and during NIDs, and poor quality of logistics management, monitoring systems and NIDs service delivery were highlighted as major constraints in polio eradication and these should be considered in prioritizing future strategies.</p

Expansion of seasonal influenza vaccination in the Americas

<p>Abstract</p> <p>Background</p> <p>Seasonal influenza is a viral disease whose annual epidemics are estimated to cause three to five million cases of severe illness and 250,000 to 500,000 deaths worldwide. Vaccination is the main strategy for primary prevention.</p> <p>Methods</p> <p>To assess the status of influenza vaccination in the Americas, influenza vaccination data reported to the Pan American Health Organization (PAHO) through 2008 were analyzed.</p> <p>Results</p> <p>Thirty-five countries and territories administered influenza vaccine in their public health sector, compared to 13 countries in 2004. Targeted risk groups varied. Sixteen countries reported coverage among older adults, ranging from 21% to 100%; coverage data were not available for most countries and targeted populations. Some tropical countries used the Northern Hemisphere vaccine formulation and others used the Southern Hemisphere vaccine formulation. In 2008, approximately 166.3 million doses of seasonal influenza vaccine were purchased in the Americas; 30 of 35 countries procured their vaccine through PAHO's Revolving Fund.</p> <p>Conclusion</p> <p>Since 2004 there has been rapid uptake of seasonal influenza vaccine in the Americas. Challenges to fully implement influenza vaccination remain, including difficulties measuring coverage rates, variable vaccine uptake, and limited surveillance and effectiveness data to guide decisions regarding vaccine formulation and timing, especially in tropical countries.</p

Global measles & rubella strategic plan

Current WHO guidance on measles outbreak response published in 1999, emphasized that most outbreaks were either detected too late or spread too rapidly to allow for an effective immunization response. This recommendation was based primarily on a literature review of manuscripts published on the impact of immunization control activities on measles outbreaks in middle- and low-income countries from 1977 to 1993. The validity of these recommendations was reviewed given recent evidence (published and from filed experience) on the impact of outbreak response immunization on measles outbreaks. This review of the evidence was carried out as follows: A consultation meeting was organized by WHO in 2006 to discuss the need for updated guidelines and to review the new evidence which supports the guidance provided in the updated document. The meeting was attended by experts from the CDC, Epicentre, MSF Belgium and MSF France, WHO and UNICEF. An extensive literature review of data (published from 1995-2006) to re-assess the impact of immunization response to measles outbreaks was carried out and the results were summarized and submitted for publication. This included a review of 277 articles. The key findings of this review are summarized in section F below. Review of data from the field and from unpublished studies on the duration of measles outbreaks and effectiveness of interventions with non-selective vaccination. Based on the initial consultations, a draft document was prepared by the Departments of Immunization, Vaccines and Biologicals and Epidemic and Pandemic Alert and Response and comments from experts were solicited. Experts were from, the CDC, the 6 WHO regional offices, MSF, Epicentre, UNICEF and from country level immunization staff and partners.Abbreviations and acronyms -- Acknowledgements -- Part I: Introduction -- A. Development of the Guidelines -- B. Rationale and public-health importance -- C. Goals of measles outbreak response -- D. Target audience -- E. Strategies for measles prevention and control: current recommendations -- F. Rationale for use of measles vaccine to control outbreaks -- Part II: Definitions -- A. Case definitions for measles surveillance and outbreak investigation -- B. Definition of a measles outbreak -- Part III: Confirming, investigating and managing an outbreak -- A. Laboratory confirmation of a measles outbreak -- B. Ensuring adequate clinical case management -- C. Intensifying surveillance and notification -- D. Assessing the risk of a large outbreak with high morbidity and mortality -- E. Investigating a confirmed measles outbreak -- F. Implementing control and preventive measures -- G. Ensuring effective community involvement and public awareness -- Part IV: Learning lessons from the outbreak -- Annex 1: Laboratory procedures -- Annex 2: The outbreak coordination committee -- Annex 3: Formulae -- Annex 4: Generic line-list for use during measles outbreaks -- Annex 5: References."WHO/IVB/09.03."This document has been jointly prepared1 by the Departments of Immunization, Vaccines and Biologicals and Epidemic and Pandemic Alert and Response at the World Health Organization in consultation with the Centers for Disease Control and Prevention of the United States Health and Human Services Department, the United Nations Children's Fund, the Me\ucc?decins Sans Frontie\ucc\u20acres, and Epicentre

From their own perspective - constraints in the Polio Eradication Initiative: perceptions of health workers and managers in a district of Pakistan's Punjab province

<p>Abstract</p> <p>Background</p> <p>The success of the Global Polio Eradication Initiative was remarkable, but four countries - Afghanistan, Pakistan, India and Nigeria - never interrupted polio transmission. Pakistan reportedly achieved all milestones except interrupting virus transmission. This paper describes the perceptions of health workers and managers regarding constraints in the Polio Eradication Initiative (PEI) to ultimately provide evidence for designing future interventions.</p> <p>Methods</p> <p>A qualitative cross-sectional study using focus group discussions and in-depth interviews was conducted in the Nankana Sahib District of Pakistan's Punjab province. Study subjects included staff at all levels in the PEI at district headquarters, in all 4 tehsils (sub-districts) and at 20 randomly selected primary health centers. In total, 4 FGD and 7 interview sessions were conducted and individual session summary notes were prepared and later synthesized, consolidated and subjected to conceptual analysis.</p> <p>Results</p> <p>The main constraints identified in the study were the poor condition of the cold chain in all aspects, poor skills and a lack of authority in resource allocation and human resource management, limited advocacy and communication resources, a lack of skills and training among staff at all levels in the PEI/EPI in almost all aspects of the program, a deficiency of public health professionals, poor health services structure, administrative issues (including ineffective means of performance evaluation, bureaucratic and political influences, problems in vaccination areas and field programs, no birth records at health facilities, and poor linkage between different preventive programs), unreliable reporting and poor monitoring and supervision systems, limited use of local data for interventions, and unclear roles and responsibilities after decentralization.</p> <p>Conclusion</p> <p>The study highlights various shortcomings and bottlenecks in the PEI, and the barriers identified should be considered in prioritizing future strategies.</p