EPI in Zimbabwe
By
Dr N.A.Gonah,
CHAIRPERSON:ZIMNITAG,NCC,CCH,UZ,CSSTWG,AMR,GNN,WHO
EPI IN ZIMBABWE-
! CHILD SURVIVAL AND ROLE OF IMMUNIZATIONS
! IMMUNIZATIONS
! ZEPI AND HISTIRICAL PERSPECTIVES
! VACCINE PREVENTABLE DISEASES/ZIM Schedule
! STRATEGIES/CI/AEFI
! COVERAGES AND TRENDS
! FUNDING AND SUSTAINABILITY(PARTNERS)
! CHALLENGES
2|
Epi in Zimbabwe
! ACHIEVEMENTS
! PLANS (GLOBAL, REGIONAL, cMYP)
3|
Child survival-components
! G-Growth monitoring/promotion
! O-Oral rehydration
! B-Breast feeding
! I-mmunization
! F-Family planning
! F-Female education
! F-Food supplementation/fortification
! E-Enviroment sanitation
! E-Essential drugs
! T-Treatment of common childhood diseases
! H-Health education
4|
EPI: one of the world’s most successful public health
programmes
! Significant progress in the past decades
– Progress with disease eradication or elimination
– 2 to 3 Millions of deaths averted per year
– Funds made available through GAVI alliance
! Ability to deliver immunization with high coverage
– Already reaching over 80% children globally
– Higher than any other intervention across continuum of care
! Increasing number of diseases now vaccine preventable
– Robust vaccine pipeline
– Progress with adding vaccines in national programmes
– From childhood to life-course vaccination
– From preventing “common” diseases to outbreak responses (JE, Dengue, Ebola…)
5|
The Decade of Vaccines Collaboration
! A process coordinated by: the African Leaders Malaria
Alliance; BMGF;GAVI Alliance, US NIAID, UNICEF and
WHO
! More than 100 technical core members in the 8 Working Groups:
• Delivery, Global Access, Public & Political Support, R&D, Costing & Funding, Health &
Economic Benefits, Accountability Framework Indicators, Communications
! Overall, around 1100 participants involved in the global consultation process
• From more than 140 countries and 290 organizations: government agencies, health
professionals, academia, manufacturers, global agencies, development partners, civil
society, private sector, PDPs
! Endorsement by the Countries of the Global Vaccine Action Plan at the WHA 65–
May 2012
6|
Vaccines and immunizations
! Work with your body’s natural defenses to build protection
! Immunization key component of primary health care and is a basic Human right
! Edward Jenner (1796 smallpox)
! Louis Pastuer
7|
Types of vaccines
! Inactivated-IPV, Hep A, rabies and most influenza vaccines
! Attenuated-MMR, BCG, yellow fever
! Toxoid-DpT
! Subunit-Hep B
! Conjugate –TCV,HiB
8|
Epi in Zimbabwe
! Launched in 1982.WHO and SIDA
! Pre independency.10-20 % of under 5s died from 6 killer diseases
! Privileged children(urban elite, school going)
! 1982, 25 % of children were protected, Today 80-92%
! Aim was to :Expand the number of immunized children. All children
by 1990
:Expand the number of vaccines given to children
:Expand coverage to all corners of the country(equity)
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VACCINE PREVENATABLE DISEASES
! 6 Killer diseases
! Hib
! Hep A & B
! Pneumococcal
! Cholera and typhoid
! Tuberculosis
! Meningococcal disease
! Yellow fever
! Mumps
10 |
VPD
! Rabies
! Varicella zoster(chicken pox)
! Influenza
! Plague
! ?malaria
! ?HIV
! ?Covid-19
11 |
Immunization schedule:Zimbabwe
! PRIMARY COURSE
Birth:BCG,HepB
6 weeks:Pentavalent 1,Rota 1,PCV 1, Bivalent OPV 1
10 weeks:Pentavalent 2,Rota 2,PCV 2, Bivalent OPV 2
14 weeks:Pentavalent 3,PCV 3, Bivalent OPV 3 +IPV
9 months: MR 1,(TCV,IPV)
10 years :HPV 1
12 |
Immunization schedule:Zimbabwe
! BOOSTERS
18 MONTHS MR2
5 years Td (tetanus, diphtheria)
10 years Td
11 years HPV 2
TT to Td Switch.
PREGNANCY-Td
13 |
Strategies
! Administrative/EPI Unit
! Cold chain
! Fixed –outreach-NIDs/SIA
! RED
! Surveillance
! EDC
! ZIMNITAG
! Polio Committees
! ICC
14 |
Global and Regional Immunization overage with three doses of
diphtheria, tetanus, and pertussis (DTP3) containing vaccines, 1980-2017,
global coverage at 85% in 2017
100
80 81 83
84 85 84 84 84 85 85 85
79 79
75 76 77
72 70 70 73 73 72 71 72 72 72 73 73 74
Coverage (%)
68
60 64
56
50 52
40 45
39
20 21
24 26
0
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
Global African American Eastern Mediterranean
European South East Asian Western Pacific
Source: WHO/UNICEF coverage estimates 2017 revision, July 2018.
Immunization Vaccines and Biologicals, (IVB), World Health Organization.
194 WHO Member States. Date of slide: 15 July 2018.
15 |
Number of vaccines/antigens introduced in national
immunization schedules - 2000 compared to 2017
Selected antigens are :
Diphtheria, Tetanus, Pertussis, Measles, Polio
- universal use
Hepatitis B,
Heamophilius Influenza type B,
Pneumococcal conjugate
Rotavirus
Rubella
2000
0 2,650 5,300 Kil
5 antigens (DTP, Measles and Polio)
6 antigens
7 antigens
8 antigens
9 antigens
≥10 antigens
Not applicable Source: WHO/IVB Database, as at 27 June 2018. Map production:
Not available
Immunization Vaccines and Biologicals, (IVB). World Health Organization.
194 WHO Member States. Date of slide: 23 July 2018.
2017
The boundaries and names shown and the designations used on this map do not imply the
expression of any opinion whatsoever on the part of the World Health Organization concerning the
16 |
legal status of any country, territory, city or area or of its authorities, or concerning the delimitation
of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which
there may not yet be full agreement. © WHO 2018. All rights reserved.
Contraindications and AEFI
! Invalid co –mild illness, antimicrobial therapy, preterm, malnutrition, acute
gastroenteritis, fever
! Valid-live vaccines with immunosuppression(e.g BCG),
-known allergy or anaphylaxis to a vaccine component eg egg,(Yellow
fever and influenza vaccine, NOT MMR).
-intussusception and rotavirus
-neurological disease or encephalopathy developed with
previous DPT(use DT instead).
17 |
AEFI
! Report all AEFIs(fill in investigating forms)
Definition-untoward medical event occurrence following
immunization.symptom,sign,diease,lab finding.
Causality assessment-vaccine related or coincidental.Signals
Fever ,convulsions, rash, local, death, syncope, buldging fontanelle, arthralgia,
gastroenteritis, exccesive crying, hypotonia
Compulsory legislation-(?public health act) vs compensation
! Public/ media-rumors(social media).
18 |
Funding/sustainability
! Partners –GAVI/WHO/UNICEF
! Co-financing
! GAVI eligible
! Vaccine procurement,staff,cold chain and
equipment,vehicles,fuel,trainings
19 |
Challenges
! Data collection and transmission tools
! Power cuts-SDD
! Transport
! Staff,stock outs,support supervision
! Public/media AEFI
! Vaccine hesitancy
! Missed opportunities
! DOR
20 |
Achievements
! Good coverages
! Wild Polio free since 2005./ARCC certification 25-08-2020.Topv to Bopv(The Switch-
April 2016).
! TT to Td
! Measles elimination(NVC)
! NIDs/SIAs
! EPI policy document/cMYP
! Committees (ZICC,ZIMNITAG,NCC,NPEC,NTF,Quarterly EPI review meetings,EPI
coverage survey.
! Demand generation
21 |
New vaccine introduction
YEAR OF INTRODUCTION NAME OF ANTIGEN
! Before ZEPI launch(1982) BCG,OPV,DTP,TT,measles
! 1999 Hep B
! 2005 Vit A incorperated
! 2008 Pentavalent(DPT-Hib-Hep B)
22 |
New vaccines introduction
! YEAR OF INTRODUCTION NAME OF ANTIGEN
2012 PCV 13
2014 Rotavirus(Rotarix)
2015 MR and MR 2
2018 HPV
2019 Inactivated Polio(IPV 1 14)
2020 Typhoid conjugate(TCV)
2021 IPV 2@ 9 months(?Hexa).
23 |
Wayforward
! GLOBAL GOALS GIVS.4 Strategic Objectives
! REGIONAL (RSPI)
! COUNTRY-cMYP,Committees
24 |
THANK YOU
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