I.

EXPANDED PROGRAM ON IMMUNIZATION TRENDS AND UPDATES

The Expanded Program on Immunization The EPI program is run by the Ministry of Health (MoH) in close cooperation with WHO, UNICEF and other partners and implemented in each region by the Regional Health Bureaus. WHO provides technical assistance to the Ministry of Health and assists in planning, resource mobilization and social mobilization. Expanded Programme on Immunization (EPI) was launched in 1974, less than five per cent of the world's children were immunized during their first year of life against six killer diseases polio, diphtheria, tuberculosis, pertussis (whooping cough), measles and tetanus. Today, nearly 79 per cent of children receive these life-saving vaccinations and increasing numbers are also protected by new and under-used vaccines, like Hepatitis B. EPI in the Western Pacific Region Since its inception in the 1970's, EPI in the Western Pacific has greatly evolved in many areas. While EPI initially focused on building sustainable routine immunization systems to protect children against common childhood diseases through administration of vaccines during infancy, achieving by 1988 less than 80% coverage of children receiving the basic set of vaccines. In 1988, when the WHO World Health Assembly (WHA) and the Western Pacific RCM endorsed resolutions to eradicate poliomyelitis (WHA 41.28 and WPR/RC39.R15), WPR - EPI embraced a new era of eradication, elimination and accelerated control of specific diseases and as a result of those efforts, the last indigenous case of poliomyelitis occurred in 1997 and poliomyelitis eradication was certified on 29 October 2000. The poliomyelitis-free status has been maintained since although several episodes of imported wild poliovirus occurred and vaccine derived polioviruses (VDPV) emerged in areas of low coverage. None of these events though resulted in sustained poliovirus transmission. Measles had declined substantially in the Region over the past 25 years and most countries had attained the 90% disease reduction goal set by the 1989 WHO World Health Assembly due to high routine coverage with measles vaccine. The introduction of hepatitis B vaccine into the routine immunization programmes of all countries was almost achieved, with Cambodia and Lao PDR scheduled for September 2001. Neonatal tetanus (NT) had been eliminated in all but five countries of the Region. In this context regional measles elimination and hepatitis B control goals were established in 2003 by the Regional Committee Meeting (RCM), WHO's governing body in the Western Pacific, and a target year of 2012 was endorsed by the RCM in 2005.

Focusing on providing hepatitis B vaccine birth dose and a second dose measles vaccine was perceived as offering new opportunities to complete the whole schedule. In the broader context of generally strengthening routine immunization services and health systems additional vaccine preventable diseases could be averted, and by fostering collaboration with mother and child health services further contributions can be made to reducing childhood mortality as well as maternal mortality, the latter mainly through prevention of tetanus. Both will support achieving the important respective Millennium Development Goals (MDG). TRENDS: I. DIPTHERIA A. International Incidence rates in the current epidemic in the newly independent states of the former Soviet Union. Incidence range from 0.5 - 1 per 100,000 population in Armenia, Estonia, Lithuania and Uzbekistan, to 27 - 32 per 100,000 in Russia and Tajikistan.Case fatality rates range from 2-3% in Russia and Ukraine, to 6-10% in Armenia, Kazakhstan, Moldova and Latvia, and to 1723% in Azerbaijan, Georgia and Turkmenistan. B. Local

II. HEPA B A. International The vaccine has an outstanding record of safety and effectiveness. Since 1982, over one billion doses of hepatitis B vaccine have been used worldwide. In many countries where 8% to 15% of children used to become chronically infected with HBV, vaccination has reduced the rate of chronic infection to less than 1% among immunized children.As of December 2006, 164 countries

vaccinate infants against hepatitis B during national immunization programmes - a major increase compared with 31 countries in 1992, the year that the World Health Assembly passed a resolution to recommend global vaccination against hepatitis B.

B. Local

III. MEASLES A. Local

IV. PERTUSSIS A. International

B. Local

V. POLIOMYELITIS A. International Polio cases have decreased by over 99% since 1988, from an estimated 350 000 cases then, to 1604 reported cases in 2009. The reduction is the result of the global effort to eradicate the disease.In 2010, only four countries in the world remain polio-endemic, down from more than 125 in 1988. The remaining countries are Afghanistan, India, Nigeria and Pakistan. B. Local *Zero incidences since 1997 (WHO).

VI. TUBERCULOSIS

A. Local

VII. TETANUS A. International

B. Local