77 WHO/IPA workshop on Immunisation

Transcription

1 77 WHO/IPA wrkshp n Immunisatin cst/efficacy f either f them des nt justify their rutine use. Cntents f such diseases shuld be within the respnsibilities f the Epidemilgy Department. XVII INTERNATIONAL CONGRESS OF PAEDIATRICS WHOjIPA PRE-CONGRESS WORKSHOP ON IMMUNIZATION 1. Intrductin CONCLUSIONS AND RECOMMENDATIONS 7 Nvember 1983 Paediatricians have lng taken a leading rle in the delivery f immunizatins and their influence ften extends beynd the families under their care. Their rle in preventing disease culd be further extended if the Natinal and Internatinal Assciatins becme invlved with and supprt the Wrld Health Organizatin Expanded Prgramme n Immunizatin (EPI)i. A Pre-Cngress Wrkshp n Immunizatin fr the XVII Internatinal Cngress f Paediatrics was held at the Wrld Health Organizatin Reginal Office fr the Western Pacific, 6-7 Nvember During the wrkshp, technical papers were presented dealing with new vaccine develpment and cnclusins and recmmendatins t prmte the applicatin f immunizatin services. Specific recmmendatins fllw: 2. Supprt fr the expanded prgramme n immunizatin Despite being ne f the mst pwerful and cst effective weapns f mdern medicine, immunizatin remains tragically unavailable r under-utilized, particularly in the develping wrld. As a cnsequence sme five millin children die frm vaccine preventable diseases each year: ten children with each passing minute. An equal number are blinded, crippled r left with mental retardatin. iestablished by the Wrld Health Assembly in 1974, the EPI seeks t expand the gegraphic cverage f existing immunizatin services and t expand the number f vaccines f public health imprtance included within natinal immunizatin prgrammes.

2 WHO/IPA Wrkshp n Immunisatin 78 The WHO Expanded Prgramme n Immunizatin has as its gal the reductin f mrbidity and mrtality frm diphtheria, pertussis, tetanus, measles, plimyelitis and tuberculsis by prviding immunizatin against these diseases fr all children f the wrld by Other diseases may be included when and where apprpriate. The wrkshp recmmends that the Internatinal Paediatric Assciatin endrse the EPI as an element f primary health care and encurage Reginal and Natinal Scieties thrughut the wrld t assist in reaching the prgramme's gal. 3. Supprt fr the frmatin f internatinal technical advisry grups n immunizatin practices Each cuntry shuld have a natinal cuncilr cmmittee t prvide advice n natinal immunizatin plicies. This cmmittee shuld include representatives f the Natinal Paediatric Sciety as well as experts frm ther relevant health disciplines. In sme cmmittees, representatin frm the cmmunity will als be apprpriate. / The cmmittee shuld prvide advice with respect t vaccine-s and immunizatin schedules recmmended in the natinal prgramme based n their review f the mst recent knwledge cncerning vaccine develpment and use and shuld recmmend natinal research pririties in their field. This cmmittee may als be cncerned with the implementatin and evaluatin f immunizatin prgrammes. The cmmittee shuld reprt t the apprpriate high level f gvernment and its recmmendatins shuld be distributed t the general medical cmmunity and the public. 4. The rle f training institutins The curricula f many medical, nursing and ther healtn training institutins d nt prvide satisfactry training with respect, t immunizatin. Training shuld nt be limited t paediatrics r public health departments and shuld reach all undergraduates. All pst-

3 79 WHO/IPA Wrkshp n Im munisatin graduate students shuld at r east be sensitized t the imprtance f immunizatin and ther preventive services. Cntinuing educatin f health wrkers shud be prvided. Training f nurses and f midwives is especially imprtant. Sme practical pints include: clear, cncise and cnvenient material examinatins shuld include relevant is required questins n immunizatin students shuld participate in immunizatin and ther primary health care activities the effects f the practical applicatin f recmmended natinal r lcal plicies shuld be reviewed selected EPI dcuments shuld be sent t schls training medical and paramedical staff in rder t prvide practical, relevant and up t date infrmatin staff invlved with the delivery f immunizatin services as well as academic staff shuld be in cntact with students. The Internatinal Paediatric Assciatin shuld, thrugh Natinal Paediatric Scieties, maintain cntact with such educatinal functins. These actins shuld all aim at increasing awareness f the imprtance f immunizatin prgrammes thrugh all grades f medical, nursing, medwifery and paramedical care. Unifrm immunizatin plicies shuld be taught in the training institutins in anyne cuntry r regin. 5. Practical guidelines fr immunizatin Lack f resurces which include staff, supplies and equipment is the majr cnstraint t the delivery f effective immunizatin services in develping cuntries. Immunizatin plicies incmpletely implemented are the main prblem in industrialized cuntries. Immunizatin plicies which are needlessly restrictive can cmpund these prblems. Natinal grups respnsible fr establishing immunizatin plicies shuld base their advice n a practical appraisal f the risks f the disease as well as the benefits and ptential risks f immunizatin. Imprtant cnsideratins include the availability and accessibility f health care services, utilizatin pat-

4 f4ho/ipa Wrkshp n Immunisatin 80 terns f these services, the ability t identify and fllw-up children wh are nt immunized, the likelihd that children will return fr subsequent immunizatin, and scicultural acceptability f specific prcedures recmmendatins. Principal recmmendatins which can serve as a general guide include: Health wrkers shuld use every pprtunity t immunize eligible children. BeG can safely and effectively be given in the newbrn perid 1 and DPT and OPV as early as six weeks f life (and, in cert.ai.n situatins, even earlier}. In cuntries where measles pses a majr burden befre the first birthday 1 measles vaccine shuld rdinarily be given at the age f 9 mnths. N vaccine is ttally withut adverse reactins, but the risks serius cmplicatins frm EPI vaccines are much lwer than the risks frm the natural diseases. It particularly imprtant t immunize children with malnutritin. Lw grade fever, mild respiratry infectins r diarrhea, and ther minr illnesses shuld nt be immunizatin. cnsidered cntraindicatins t I~munizatin f children s ill as t require hspitalizatin shuld be deferred fr decisin by the hspital authrities. The immunizatin status f hspitalized children shuld be evaluated, and they shuld receive apprpriate immunizatin befre discharge (in sme cases they shuld be immunized n admissin, because f the high risk f hspital-acquired measles). A secnd r third DPT injectin shuld nt be given t a child wh has suffered a severe adverse ractin t the previus dse. The pertussis cmpnent shuld be mitted and diphtheria and tetanus immunizatin cmpleted. Diarrhea shuld nt be cnsidered a cntraindicatin t OPV, but t ensure full prtectin, dses given t children with diarrhea shuld nt be cunted as part f the series and the child shuld be given anther dse at the first available pprtunity.

5 81 WHO/IPA Wrkshp n Immunisatin 6. The prmtin f immunizatin services within primary health care All maternity and child health services shuld help prmte immunizatin as a part f their nrmal duties and pl their resurces apprpriately t achieve effective cverage. Paediatricians themselves must take a leading rle. Immunizatin shuld be prmted as part f nrmal family care. Each child shuld have a chart recrding immunizatin, grwth and develpment kept at hme. T prevent nenatal tetanus, paediatricians shuld wrk with bstetricians and ther health care prviders t assure that wmen f child-bearing age, especially pregnant wmen, are adequately immunized against tetanus and t assure that delivery and care f the umbilical crd are hygienic. Data cncerning bth immunizatin cverage and disease incidence fr all the target diseases shuld be available t staff at lcal and natinal level t permit the effectiveness f the prgramme t be mnitred. Schl entry is a time when evidence f immunizatin can be required. Health educatin at schls shuld include the value f breastfeeding, immunizatin and hygienic fd and clean water as nrmal steps in the preventin f illness. Cmmunity leaders shuld be actively invlved in prmting immunizatin. The media shuld be used t the ~ fullest extent but care shuld be taken that the services being prmted can acutally be prvided. 7. Cmmunity participatin Paediatricians shuld take the initiative in enlisting supprt f cmmunity leaders fr immunizatin, in particular: schl teachers, village leaders, pliticians, wmen's grups, midwives, nurses, and ther primary health care wrkers. In schls, reading primers shuld include infrmatin n immunizatin and ther preventive health measures. The help f religius leaders shuld als be slicited. They culd prmte the use f immunizatin and ther primary health care services, and culd make specific inquiry cncerning the child's immunizatin status, as fr example, at the time f baptism.

6 WHC/IPA Wrkshp n Im munisatin 82 Lcal special events shuld be prmted t infrm the cmmunity abut immunizatin and its imprtance, fr example by: invlving vluntary rganizatins in special events rganizing pster cntests fr schl children encuraging schl children t assure that their yunger siblings are immunized. Paediatricians shuld becme invlved with the mass media (radi, televisin, newspapers, wmen's magazines, etc) in the preparatin f prgrammes and articles t ensure that technically accurate cnsistent infrmatin is cmmunicated and that immunizatins are encuraged in terms the lay persn understands. Unifrm immunizatin plicies shuld be adpted in anyne cutry r regin t avid cnfusing the public. 8. Rles f paediatric assciatins in prmting the utilizatin f immunizatin services Paediatricians and their scieties shuld be the primary advcates fr child health. Paediatricians shuld help mnitr the scientific evidence n which immunizatin is based and prmte research as apprpriate t ensure the benefits and hazards are adequately and accurately assessed. Paediatric scieties shuld play a leading rle in develping plicies at natinal level thrugh active participatin in plicy frming cmmittees and shuld publicly endrse thse plicies. Paediatric scieties may appint an expert cmmittee devted t the preventin and cntrl f infectin and such a cmmittee shuld serve as a surce f authritative infrmatin and advice n immunizatin practices t health authrities, practicing physicians, and the public media. Individual paediatricians shuld be encuraged t make themselves readily available t ffer advice and supprt t all thse prviding immunizatin services, t parents, and thers within their wn cmmunity.

7 83 WHO/IPA Wrkshp n Immunisatin Educatin n immunizatin shuld be actively prmted at several levels, by: participatin in medical educatin, t ensure nt nly adequate training in the principles and practice f immunizatin, but als the imprtance f dctrs in influencing public knwledge and attitudes, and in encuraging recruitment t preventive paediatrics and epidemilgy. participatin in nursing and paramedical training in immunizatin practice and in public health educatin. influencing pliticians in pririties fr immunizatin prgrammes within health service budgets and plicies ensuring cntinuing educatin f dctrs and primary health care wrkers in relatin t immunizatin plicies and the maintenance f high vaccine acceptance rates. Paediatric scieties shuld prvide supprt fr adequate funding f immunizatin prgrammes and shuld supprt the adptin f legislatin which facilitates the applicatin f immunizatin services. Paediatric scieties shuld invlve themselves in and assist the activities f nn-gvernmental rganizatins with an interest in children's welfare. 9. Research and develpment Advances in scientific knwledge prvide increasing pprtunities t develp new vaccines, and t imprve the safety, effectiveness and utilizatin f existing vaccines. Paediatricians shuld lend their supprt t basic vaccine research, field trials t evaluate new vaccines, and peratinal research t imprve the applicatin f existing vaccines. Areas f interest include the impact f legislatin requiring immunizatin as a pre-requisite t schl entry and the review f ther plicies and practices which are thught t serve as incentives r disincentives t the acceptance f immunizatin services. Medical schls shuld be encuraged t be actively invlved in applied research pertaining t immunizatin and ther primary health care initiative.