Routine Immunization in the WHO African Region: Progress; Challenges and Way Forward

Tremendous progress has been made in expanding immunization in the African Region over the last four decades. And immunization; together with other primary health care and development interventions; has impacted significantly on the annual number of deaths among children under five. However; an estimated 22 (4.3 million) of the infants globally remaining unimmunized are located in four countries of the African Region (Democratic Republic of the Congo; Ethiopia; Nigeria and South Africa). Challenges remain in reaching an estimated 20-30 of children across the Region. In addition to the traditional vaccines (DTP; measles; polio and tuberculosis) newer ones; such as for PCV and rotavirus; are being rolled out in the Region but uptake and coverage is slow and patchy both within and between countries. The new regional strategic plan for immunization 2014-2020 is intended to provide policy and programmatic guidance to Member States; in line with the 2011- 2020 GVAP; in order to optimize immunization services and assist countries to further strengthen their immunization programmes

Rotavirus Disease Burden in Africa and the Need to Accelerate Introduction of Vaccines

It is important to establish the burden of rotavirus disease before and after the introduction of a rotavirus vaccine. Regional effortshave focused on building an unequivocal evidence base for rotavirus diarrhoea to support decisionmaking and sustained investment in new vaccine introduction. WHO recommends routine use ofrotavirus vaccines in all countries; particularlyin those with high mortality attributable todiarrhoeal disease. In countries where diarrhoeal deaths account for more than 10 of mortality inchildren aged under five years; the introduction of the vaccine is strongly recommended. This article reviews the available literature and summarizesthe estimated number of deaths in children underfive years attributable to rotavirus diarrhoea in the WHO African Region. Based on the available data; it can be concluded that the rotavirus disease burden is very high and that the introduction of rotavirus vaccines should be accelerated in the Region

Polio Eradication in the African Region: Progress and Way Forward

In 2012 the declaration of global polio eradication as a programmatic emergency for public health targets resulted in the setting of objectives and a schedule for eradication. Innovative approaches were taken to address the polio situation in the African Region. Supplementary immunization activities; planning; monitoring and surveillance have all been stepped up; and technological advances such as GPS and the use of polio dashboards to monitor key performance data have been employed. Key priority countries (Angola; Chad; Democratic Republic of the Congo; Nigeria) and communities (including nomadic groups) have been targeted.Great progress has been documented; for example routine immunization has risen from less than10 in 1980 to 77 in 2013. However; there are still some challenges to overcome; notably wild poliovirus outbreaks and three remaining foci of transmission - Nigeria; the Central Africa subregion and the Horn of Africa. This article charts the steps taken and the continuing action needed to realise the aim of polio eradication

Measles Elimination in the WHO African Region: Progress and Challenges

In 2001; countries in the African Region adopted the measles mortality reduction strategies recommended by the WHO and UNICEF. Following the significant reduction in measles cases and deaths with the implementation of the strategies; in 2011; the African Region adopted a measles elimination goal for 2020. To assess progress; performance was reviewed using estimates of the first dose of measles vaccine in routine immunization (MCV1); the reported coverage for measles supplementary immunization activities (SIAs); as well as surveillance data. During 2011-2013; regional MCV1 coverage was stagnant at around 74; while approximately 215 million children were reached in measles SIAs in 43 countries. Regional measles vaccination coverage has not increased and measles incidence has remained high in the past three years. Intensive efforts are required to ensure that routine immunization and SIAs provide high population immunity; and to increase the sensitivity of measles surveillance

Update on Elimination of Epidemic Meningitis in the African Region

At the demand of the African ministries of health; a new conjugate vaccine was developed by Serum Institute of India Limited (SIIL) against meningococcal A meningitis; the germ responsible for more than 95 of the meningitis epidemics in Africa; through a partnership between WHO and PATH and; with the financial support from the Bill et Melinda Gates Foundation. The vaccine is being introduced in all the 26 countries of the meningitis belt between 2010 and 2016. So far; 153 million people have been vaccinated in 12 countries. The vaccine is efficacious; no case of meningococcal meningitis A has been identified among vaccinated individuals and in post-campaign carriage studies. The overall number of meningitis cases dropped sharply during epidemic seasons in the countries of the belt. The vaccine will be introduced via routine immunization by the end of 2015

Progress towards the Elimination of Maternal and Neonatal Tetanus

Over the last 25 years impressive progress has been made on the elimination of maternal and neonatal tetanus worldwide including in the African Region. In 1999 a global initiative was launched to eliminate it completely with a global target date of 2015. This article looks at the progress made across the African Region and the challenges remaining and strategies being implemented for those countries yet to achieve the goal

Surveillance for Diseases Targeted by new Vaccines: Progress; Challenges and Way Forward

Thirteen years ago; WHO-AFRO proposed the establishment of a sentinel disease surveillance network as part of efforts to improve surveillance for invasive bacterial diseases (IBD) including paediatric pneumonia and meningitis and rotavirus diarrhoea in all Member States as part of surveillance for vaccine-preventable diseases and in line with the regional strategy integrated disease surveillance and response (IDSR). This was prompted by the eminent availability of new and prospective vaccines against Haemophilus influenzae type b (Hib); Streptococcus pneumoniae (S. pneum); Neisseria meningitides (Nm) and rotavirus vaccines. The Regional Office for Africa developed guidelines and tools and standardized methodology; including cases definitions to be used to recruit eligible cases. This article outlines the challenges and results of this initiative to date and aims for the future

Overview of the WHO Polio Laboratory Network in the African Region

The Polio Laboratory Network has always played a critical role in diagnosing poliovirus disease (poliomyelitis) and the detection of poliovirus transmission. In the new millennium; the strength of the laboratory network is often a direct reflection of the success of the Polio Eradication Initiative (PEI) programme. The network has taken advantage of new technologies that provide speedy turnaround times for results reporting thus contributing to the success of the PEI programme. This article presents a brief overview of the work of the network

Immunization Monitoring and Vaccine-Preventable Diseases Surveillance Data Management in the African Region

Countries in the WHO African Regionhave well-established national immunization programmes and disease control programmes working towards the different goals for the control of vaccine-preventable diseases; and generating coverage and surveillance data. WHO provides technical support to standardize the approaches; methodology; and tools used for data management. The datasets are shared with WHO for purposes of monitoring the coverage and disease trends across the Region. This article reviews the methods WHO employs to build capacity in this field of data management across the Region and the resultant achievements and gaps. Despite the recent improvements in some aspects of data quality; important policy; technical and managerial gaps remain; which need to be addressed in order to ensure that the data coming out of these national programmes are of optimal quality

African vaccination week: platform for effective partnership to deliver multiple interventions in the African Region

African Vaccination Week (AVW) is an initiative of the countries in the World Health Organization African Region promoting equity and access to vaccination. The initiative focuses on reaching populations with limited access to regular health services. Available data from 2014 showed that countries took advantage of the initiative to conduct integrated delivery of multiple interventions; targeting those with limited access to regular health services. A majority of the countries integrated between five and six interventions and very few delivered single interventions. The most common integrated intervention was vitamin A supplementation; followed by de-worming. Other interventions included educational activities; supplementation minerals and provision of health services. Data on coverage of integrated interventions are shown in the article