Developing standardized competencies to strengthen immunization systems and workforce

Despite global support for immunization as a core component of the human right to health and the maturity of immunization programs in low- and middle-income countries throughout the world, there is no comprehensive description of the standardized competencies needed for immunization programs at the national, multiple sub-national, and community levels. The lack of defined and standardized competencies means countries have few guidelines to help them address immunization workforce planning, program management, and performance monitoring. Potential consequences resulting from the lack of defined competencies include inadequate or inefficient distribution of resources to support the required functions and difficulties in adequately managing the health workforce. In 2015, an international multi-agency working group convened to define standardized competencies that national immunization programs could adapt for their own workforce planning needs. The working group used a stepwise approach to ensure that the competencies would align with immunization programs' objectives. The first step defined the attributes of a successful immunization program. The group then defined the work functions needed to achieve those attributes. Based on the work functions, the working group defined specific competencies. This process resulted in three products: (1) Attributes of an immunization program described within eight technical domains at four levels within a health system: National, Provincial, District/Local, and Community; (2) 229 distinct functions within those eight domains at each of the four levels; and (3) 242 competencies, representing eight technical domains and two foundational domains (Management and Leadership and Vaccine Preventable Diseases and Program). Currently available as a working draft and being tested with immunization projects in several countries, the final document will be published by WHO as normative guidelines. Vertical immunization programs as well as integrated systems can customize the framework to suit their needs. Standardized competencies can support immunization program improvements and help strengthen effective health systems.

Atualização em vacinas, imunizações e inovação tecnológica / Vaccines, immunization and technological innovation: an update

A erradicação da varíola foi a maior conquista da saúde pública mundial. E o binômio vacinas e imunizações continua a demonstrar alto desempenho na prevenção e no controle de outras doenças imunopreveníveis. As novas iniciativas globais em vacinação, como a GAVI, vêm possibilitando a introdução de novas vacinas e salvando vidas de milhares de crianças nos países mais pobres do mundo. O Programa Nacional de Imunizações (PNI) do Brasil também vem sendo fortalecido com a incorporação de novas vacinas no seu calendário de imunizações, como a vacina contra rotavírus, pneumococos conjugada, meningite meningocócica do sorogrupo C conjugada, além do H1N1 para as populações de maior risco. Com o descobrimento de novas vacinas de alto valor agregado, os grandes laboratórios multinacionais despertaram para este segmento farmacêutico e buscam a liderança da área, investindo maciçamente em inovação tecnológica, além de realizar fusões, aquisições e parcerias tecnológicas. O Brasil também vem se fortalecendo, tendo criado marcos reguladores e financiando projetos de inovação tecnológica e modernização da infraestrutura de produção.

The smallpox worldwide eradication was the major world public health achievement. The binomial vaccines and immunization continues to demonstrate very high performance in the prevention and control of other diseases preventable by vaccination. The new global initiatives on vaccination, such as GAVI, have made possible the introduction of new and important vaccines preventing million of children deaths in the poorest countries in the world. The National Immunization Program of Brazil is also being strengthened, with the introduction of several new vaccines into the basic calendar as rotavirus, pneumococcal and meningococcal conjugated and H1N1 in national campaign, covering the population at risk. With the discovery of high valued vaccines, the big pharmaceutical companies became interested in this area, investing heavily in technological innovation, making fusions, acquisitions and technological partnerships. Brazil has also established a new innovation policy, creating new laws as well as subsidizing projects in technological innovation and modernization of production infra-structure.

Descriptive analysis of immunization policy decision making in the Americas / Análisis descriptivo de la toma de decisión sobre políticas de vacunación en las Américas

OBJECTIVES: Reducing and eliminating vaccine-preventable diseases requires evidence-based and informed policy decision making. Critical to determining the functionality of the decision-making process for introduction of a new vaccine is understanding the role of the national immunization technical advisory group (ITAG) in each country. The aim of this study is to document the current situation of national level immunization policy decision making for use in the Pan American Health Organization (PAHO) ProVac Initiative. METHODS: A structured 66-variable questionnaire developed by the World Health Organization (WHO) in collaboration with the University of Ottawa was distributed to all WHO regions; it was composed of dichotomous, multiple-choice, and open-ended questions. Questionnaires were e-mailed or faxed to the six WHO regional offices and the offices distributed them to all member states. This paper analyzes surveys from the Americas as part of PAHO's ProVac Initiative. RESULTS: Twenty-nine countries of the Americas answered the survey. They conveyed that immunization policy making needed to be improved and further supported by organizations such as PAHO. Areas of improvement ranged from organization and technical support to strengthening capacity and infrastructure to improved coordination among stakeholders. This survey also highlighted a variety of ITAG processes that need further investigation. CONCLUSION: This survey supports the efforts of PAHO's ProVac Initiative to disseminate knowledge and best practices for an immunization policy decision-making framework through the development of clear definitions and guidelines. By highlighting each problem noted in this study, ProVac will assist countries in Latin America and the Caribbean to build national capacity for making evidence-based decisions about introduction of new vaccines.

OBJETIVOS: Para reducir y eliminar las enfermedades prevenibles por vacunación se requiere tomar decisiones basadas en datos científicos y una política informada. Con el fin de determinar la funcionalidad del proceso de toma de decisiones para introducir una nueva vacuna es vital comprender el papel de los grupos técnicos asesores nacionales sobre vacunación (GTAN) de cada país. En este trabajo se documenta la situación actual de la toma de decisión sobre políticas de vacunación a nivel nacional como insumo de la Iniciativa ProVac de la Organización Panamericana de la Salud (OPS). MÉTODOS: Se distribuyó a todas las regiones de la Organización Mundial de la Salud (OMS) un cuestionario estructurado con 66 variables, desarrollado por la OMS en colaboración con la Universidad de Ottawa, Canadá. El cuestionario contenía preguntas abiertas, dicotómicas y de selección múltiple y se envió por correo electrónico o fax a las seis oficinas regionales de la OMS y estas lo distribuyeron a todos los estados miembros. En este manuscrito se analizan las respuestas procedentes de las Américas, como parte de la Iniciativa ProVac de la OPS. RESULTADOS: Respondieron la encuesta 29 países de las Américas. Todos coincidieron en que la formulación de políticas de vacunación debe mejorar y se necesita más apoyo de organizaciones como la OPS. Las áreas que requieren mejoras van desde la organización y el apoyo técnico hasta el fortalecimiento de la capacidad y la infraestructura, y el perfeccionamiento de la coordinación entre los diferentes actores. También se destacan algunos procesos de los GTAN que requieren mayor investigación. CONCLUSIÓN: Esta encuesta apoya los esfuerzos de la iniciativa ProVac de la OPS para diseminar el conocimiento y las mejores prácticas para elaborar un marco de trabajo para la toma de decisiones sobre políticas de vacunación mediante el desarrollo de definiciones y directivas claras. Al poner de manifiesto cada problema observado ...

Niveles de eficiencia de las policlínicas de Matanzas, Cuba, según el método de análisis envolvente de datos / Efficiency of outpatient clinics in Matanzas, Cuba, using data envelopment analysis

OBJETIVOS: Determinar el índice de eficiencia de todas las policlínicas de la provincia de Matanzas, Cuba, identificar las unidades de mejor práctica y estimar las reservas de eficiencia de cada unidad. METODOLOGÍA: Se realizó una investigación descriptiva durante el primer trimestre de 2006 en las 40 policlínicas de la provincia de Matanzas, Cuba. Las policlínicas se agruparon según su nivel de complejidad y el nivel socioeconómico del municipio en el que se ubican. Se consideraron cinco indicadores de resultados y seis de recursos. Para los cálculos se empleó el análisis envolvente de datos y se asumieron el modelo de maximización de resultados y los supuestos de rendimientos constantes y variables a escala. RESULTADOS: La eficiencia relativa de las unidades estudiadas fue alta, con un valor medio de 0,95 ± 0,11. Once (27,5 por ciento) de las policlínicas estudiadas fueron ineficientes (0,77 ± 0,12). Las principales reservas para elevar la eficiencia fueron aumentar la detección de los casos de tuberculosis en la comunidad, reducir el índice de mortalidad infantil evitable y ampliar la cobertura de inmunización. En las 11 policlínicas ineficientes había holgura de recursos en al menos un indicador. CONCLUSIONES: La identificación de policlínicas de referencia permitió aportar elementos organizacionales que podrían contribuir a mejorar la eficiencia de las unidades deficientes. Debe revisarse el proceso de asignación de recursos para evitar el exceso de recursos innecesarios como vía para aumentar la eficiencia.

OBJECTIVES: To rate the efficiency of all the outpatient clinics in Matanzas, Cuba; identify the best-performing clinics; and find opportunities for improvement at the others. METHODS: A descriptive study of the 40 outpatient clinics in the province of Matanza was carried out during the first trimester of 2006. Clinics were grouped according to the complexity of services they offer and the socioeconomic level of the municipality in which they are located. Five output and six input variables were analyzed. Calculations were performed using data envelopment analysis, including optimization of results and constant and variable returns-to-scale. RESULTS: In general, the clinics studied had high efficiency rates, with a mean of 0.95 ± 0.11. Eleven (27.5 percent) clinics studied were rated inefficient (0.77 ± 0.12). The following Three key areas for improvement were identified: increasing tuberculosis detection rates in the community, reducing rates of preventable infant mortality, and expanding immunization coverage. Among the 11 clinics rated as inefficient, there were resource gaps in at least one indicator. CONCLUSIONS: By recognizing successful clinics, best practices were identified that could be used to improve the weaker clinics. The resource distribution process should be reviewed to ensure that additional, unneeded resources are not used to improve efficiency.

Efficacy of VP2 protein expressed in E. coli for protection against highly virulent infectious bursal disease virus

The ability of a heat-inactivated whole virus from a highly virulent infectious bursal disease virus (hvIBDV) and VP2 protein from hvIBDV expressed in E. coli provided protection against a hvIBDV challenge in specificpathogen- free (SPF) chickens. Six out of seven chickens that were injected three times with crude VP2 protein developed significant antibody titer against IBDV. However, only four out of the seven chickens survived the hvIBDV challenge. Despite showing low antibody titer profiles, all chickens immunized with the heat-inactivated whole virus also survived the challenged with hvIBDV. However, all of these chickens had bursal atrophy and mild to moderate depletion of lymphocytes. Thus, antibodies raised against IBDV VP2 protein expressed in E. coli and denatured IBDV proteins induced some degree of protection against mortality but not against bursal damage following challenge with hvIBDV.

Identification of seronegative pregnant women eligible for immunization against rubella

To estimate the frequency of Rubella seropositivity among pregnant women and thereby getting an estimate of seronegative women who should eventually be immunized against Rubella. A blood sample of 100 consecutive pregnant women coming for their first antenatal check-up at Shifa International Hospital, Islamabad, was collected in the year 2002. Enzyme-Linked immunosorbent assay [ELISA] technique was used to detect IgG antibodies against Rubella. Out of 100 pregnant women 61[61%] were positive for rubella [IgG antibodies] in the first trimester of pregnancy. Mean age of the study participants was 27 ' 3.27 years. Twenty-five [25%] women were primigravida, while 75 [75%] were multigravida. Majority of the women were housewives belonging to middle and lower middle socioeconomic class. We found 61% women had positive Rubella antibodies during first antenatal visit. Nearly 40% who were negative should be immunized against rubella, preferably before conception

Health status of siblings of hospitalized children.

OBJECTIVE: To study health status of siblings of children hospitalized for various diseases. METHODS: A total of 308 siblings of 200 hospitalized children were studied by detailed history, anthropometry, physical examination and relevant laboratory tests. RESULTS: Only 43.83% siblings were fully immunized, 25.32% partially and 30.85% were totally unimmunized. Normal nutritional status was seen in 20.43% siblings; 26.95% had grade 1, 25.64% grade II, 24.02% grade III and 2.92% had grade IV malnutrition. Various morbid conditions were observed in siblings, the common ones were vit. A deficiency (22.40%), worm infestation (21.42%), anemia (19.15%), dental caries (13.63%), ARI (13.31%), diarrhoea (12.01%), malaria (7.46%) and scabies (7.14%). CONCLUSION: The siblings of hospitalized children are in a high-risk group as they share same environment and nutrition. They have various ailments in various stages of severity. The health screening of such children will have a positive impact in promoting health and diagnosing diseases at an early stage.

Assessment of vaccine wastage during a pulse polio immunization programme in India.

A study to assess the wastage factor of oral polio vaccine (OPV) in the Pulse Polio Immunization (PPI) programme of the Government of India was undertaken by the Indian Council of Medical Research (ICMR) at approximately 31,000 immunization booths all over the country. The study was conducted through the network of 31 Human Reproduction Research Centres (HRRCs) and other ICMR institutes. Wastage at the point of administration of OPV was estimated to be 14.5% with a wastage factor of 1.17 which is well below the assumed wastage of 33% and the corresponding wastage factor of 1.5 in the PPI programme. The wastage and wastage factor as estimated in the present study were also less than the wastage of 25% and the wastage factor of 1.33 recommended by the World Health Organization. Minimum wastage (6.3%) at Kanchipuram and maximum wastage (22.1%) at Kanpur were observed. Further, the wastage of unopened vials and vials during use was also observed following colour changes on the vaccine vial monitor (VVM), indicating poor cold-chain maintenance at the immunization site. In total, 13 booths reported wastage of nine or more unopened vials, whereas 19 booths reported wastage of nine or more vials during use because of colour changes on VVM. Other reasons for wastage of vaccine were also observed from a sample of booths. The technology of introducing VVM on OPV vials for monitoring the cold-chain proved useful in situations in which mass vaccination programmes such as PPI are carried out.

Combination vaccines.

Recently multiple individual vaccines were put together into one syringe. This is ideal to simplify the administration of vaccines and reduce emotional distress from multiple injections. However, combination of many vaccines may interfere with the properties of each individual antigen and complicate the schedule. From earlier studies, most of the combinations of diphtheria-tetanus-pertussis (whole-cell) vaccine (DTPw), Haemophilus influenzae type b vaccine (Hib), hepatitis B vaccine (HBV), and inactivated polio vaccine (IPV) were safe and adequately immunogenic. On the other hand, there was a notable reduction in anti-PRP when Hib was combined with acellular pertussis vaccine (DTPa). Combination of hepatitis A vaccine and HBV was safe and effective. Those coming soon in the pipeline are DTPa-Hib-HBV, MMR-varicella, pneumococcal-meningococcal. With the increase in demand, health-care providers need to be acquainted to these combination vaccines. The bottom line is to make sure that the children get vaccination appropriately.

Para la vida / Kawsanapak / Facts for Life

Su finalidad es convertirse en un instrumento para proteger y salvar la vida y la salud de las niñas y niños conociendo sobre desarrollo infantil, maternidad sin riesgos, lactancia materna, nutrición y crecimiento, inmunización, enfermedades transmisibles...

Manual de procedimentos para vacinaçäo / Handbook of vaccination procedures

Os dois objetivos básicos do Manual persistem: estabelecer as linhas gerais para a administraçäo dos imunobiológicos na rede de serviços de saúde; e padronizar e disciplinar os critérios e técnicas para a administraçäo de vacinas e soros utilizados pelo Programa Nacional de Imunizaçöes

Manual de normas de vacinaçäo / Handbook of vaccination norms

Opta pelo conteúdo técnico-científico, mantem a orientaçäo de que as questöes relacionadas à operacionalizaçäo deverá ser atendidas através do Manual de Procedimentos para Vacinaçäo. Encontra-se as orientaçöes relativas à vacinaçäo da populaçäo indígena, produto de profundas discussöes com todos os segmentos da sociedade envolvidos com a questäo

Manual de normas y procedimientos 2001 / Manual of norms and procedures 2001

El documento presenta El manual de normas y procedimientos 2001 actualizado con el objetivo de proporcionar las bases legales del programa que son de orden público y privado, de interés nacional y que son de estricta obligatoriedad para todos los trabajadores del sector. Además presenta la reseña histórica del PAI en la Región, Conceptos básicos de inmunidad, las vacunas del PAI, las prácticas y aplicación de vacunas, los Procedimientos para las prácticas de vacunación, Las normas nacionales de inmunización, Reacciones adversas en las prácticas de vacunación, la cadena de frio, el sistema de gerencia y suministro del PAI (CLM), Sistema de información del PAI, las Normas básicas de la vigilancia epidemiológica de las enfermedades prevenibles por vacuna, Las normas del laboratorio para la toma y manejo de muestras de las enfermedades prevenibles por vacunas.

Sociomedical correlates of missed opportunities for immunisation.

Missed opportunity for immunisation is one of the hurdles in the achievement of 85 percent or more immunisation coverage. It is essential to screen every child for immunisation status and advise necessary immunisation at every opportunity otherwise full immunisation coverage may not be possible. Present survey was carried out at Indira Gandhi Medical College and Hospital, Nagpur to study the sociomedical correlates of missed opportunities for immunisation in children below 2 years of age attending the hospital. Missed opportunities for immunisation in these children was found to be 39.9%. It is mostly for B. C. G. (21.8%) and measles (9.8%) and maximum for booster doses of DPT and polio (43%).