Immunization in the Americas...levels >95% for all childhood vaccines in all municipalities. 2. Addressing the unfinished immunization agenda. First, coverage levels are not homogenous

Immunizationin the Americas

2008 Summary

Comprehensive Family ImmunizationFamily and Community Health

preface

Published annually, Immunization in the Americas serves as a benchmark for monitoring the progress of national immunization programs in the following three main strategic areas of work:

1. Protecting the achievements. The Americas have been the first Region in the world in eradicating poliomyelitis and eliminating endemic measles transmission. National immunization programs in the Americas have reached approximately 90% vaccination coverage for all childhood vaccines, leading to epidemiological control of diphtheria, tetanus, pertussis, hepatitis B, and invasive disease caused by Haemophilus influenzae type b. However, to protect these achievements, it is necessary that countries aim to reach and maintain coverage levels >95% for all childhood vaccines in all municipalities.

2. Addressing the unfinished immunization agenda. First, coverage levels are not homogenous between and within countries, leading to pockets of unvaccinated persons at risk of contracting vaccine-preventable diseases. Overall, 44% of the municipalities of Latin American and Caribbean countries report not having reached 95% coverage with three doses of diphtheria-tetanus-pertussis vaccine. Second, seasonal influenza vaccine use in Latin American and Caribbean countries needs to be extended to all at-risk groups. Third, yellow fever has not been fully controlled in all enzootic areas of the Region, and the risk of yellow fever reurbanization in the Americas does exist. Finally, countries have made great strides toward eliminating rubella and congenital rubella syndrome by 2010, as mandated by the Ministers of Health of the Americas during PAHO’s 2003 Directing Council. Each country must now verify elimination to document the Region’s measles- and rubella-free status.

3. Meeting new challenges. Countries must adapt to a growing number of vaccines and more complex demands placed on the immunization program at all levels. The effectiveness of these new vaccines varies by country. They are also much more costly than traditional childhood vaccines. Therefore, countries will have to make policy decisions based on a broader base of evidence, supported by a strong national surveillance and a robust laboratory network to evaluate disease burden and vaccine impact after introduction. Also key will be economical evaluations to take into account both high vaccine price and the logistical aspects of new vaccine introduction. PAHO’s Pro-Vac initiative is providing countries with tools to conduct economic and cost-effectiveness studies to help them make decisions regarding new vaccine introduction. Also, PAHO’s Revolving Fund for Vaccine Procurement will continue to ensure that quality vaccines are available at an affordable price to all countries of the Americas.

It is paramount to ensure that national immunization programs remain strong and sustainable so they can continue to catalyze the growth and achievements of primary care services. To that end, Immunization in the Americas provides an overview of vaccine-preventable disease and immunization data from all countries of the Americas.

Mirta Roses Periago Director

Pan American Health Organization

For this publication:• Latin America is composed of Mexico, Central American Isthmus, Latin Caribbean, Andean Area, Brazil, and Southern Cone.• Latin America & Caribbean is composed of Latin America and Non-Latin Caribbean.• Because of their population size, Brazil and Mexico are shown separately.

demographic and socioeconomic data

The Americas

North AmericaBermuda

CanadaUnited States of America

Latin America & the Caribbean

Latin America

Mexico

Central American IsthmusBelize

Costa RicaEl SalvadorGuatemalaHondurasNicaragua

Panama

Latin CaribbeanCuba

Dominican RepublicFrench Guiana

GuadeloupeHaiti

MartiniquePuerto Rico

Andean AreaBolivia

ColombiaEcuador

PeruVenezuela

Brazil

Southern ConeArgentina

ChileParaguayUruguay

Non-Latin CaribbeanAnguilla

Antigua & BarbudaAruba

Bahamas, TheBarbados

Cayman IslandsDominicaGrenadaGuyanaJamaica

MontserratNetherlands Antilles

Saint Kitts & NevisSaint Lucia

Saint Vincent & the GrenadinesSuriname

Trinidad & TobagoTurks & Caicos Islands

Virgin Islands (UK)Virgin Islands (US)

2007

1total

population(thousands)

crudebirthrate

(1,000 pop)

annualbirths

average(thousands)

populationbelow int’l

poverty line (%)(latest available)

women ofchildbearingage (WCBA)(thousands)

gross national income (US$ per capita)

currentvalue

pppvalue

publicexpenditure

privateexpenditure

infant mortality rate ornumber of deaths (N)

(1,000 lb)

rate

national health expenditureas a % of GDP

2 3 4 5 6 7 8 9 10

2007 2007 2007 2006 2006 2004 20041998-04 910,951

338,768 66

32,876 305,826

572,183

565,223

106,535

41,019 288

4,468 6,857

13,354 7,106 5,603 3,343

35,663 11,268

9,760 202 445

9,598 399

3,991

124,582 9,525

46,156 13,341 27,903 27,657

191,791

65,633 39,531 16,635

6,127 3,340

6,960 14 69

104 331 294

47 69

106 738

2,714 10

192 39

165 120 458

1,333 22 24

111

15.1

11.911.310.314.0

18.2

20.2

19.3

24.725.217.822.833.227.924.920.8

18.010.323.523.914.827.912.413.3

21.927.318.721.020.921.4

19.2

18.117.515.024.815.1

16.314.016.614.116.911.012.614.818.017.119.917.512.517.919.120.119.514.821.514.813.4

16,076.7

4,639.70.7

341.24,297.8

11,437.0

11,315.5

2,075.3

1,106.07.3

79.9157.6450.3200.3140.4

70.2

687.0116.3230.7

4.96.6

270.24.9

53.4

2,597.7262.7869.5281.6586.1597.8

3,697.8

1,151.7696.4251.4153.4

50.5

121.50.21.21.45.63.20.61.01.9

12.554.0

0.22.40.73.22.48.9

19.80.50.31.5

236,976

83,094

8,17374,921

153,882

152,077

29,583

10,50874

1,2091,8223,2391,8071,480

877

9,2602,9962,525

11551

2,470103

1,001

33,2742,364

12,6983,4377,4437,332

52,709

16,7439,9444,4471,543

809

1,805……289382

……27

182719…52

…4633

122394……27

20,040

43,928…

36,65044,710

4,952

4,969

7,830

2,6143,7404,9802,6802,5901,270

9305,000

……

2,910……430……

3,5681,1003,1202,9102,9806,070

4,710

5,2275,1506,8101,4105,310

5,544…

11,050…………

4,1604,6501,1503,560

……

8,4605,0603,3204,210

12,500………

22,268

43,314…

36,28044,070

8,961

8,998

11,990

5,3307,0809,2205,6105,1203,4202,7208,690

……

5,500……

1,070……

7,1833,8106,1306,8106,490

10,970

8,700

10,77111,67011,300

4,0409,940

9,369…

15,130……

15,150…

7,8708,7703,4107,050

……

12,4408,5006,2207,720

16,800………

16.1

6.8NA5.46.9

20.2

20.2

15.7

22.317.210.121.5…

23.033.014.8

34.55.3

30.710.4

7.157.0

6.18.7

21.554.015.920.121.016.5

21.2

12.412.9

7.618.011.9

……

21.8NA

17.614.2

NANA

11.022.0…NA…NA

15.026.219.116.5

NANANA

1

3

613

1

15

26

11

(N)

200520052005

2007

200720072007

200620062006

2007200720032005200620032006

20032005200620032006

2005

2006200620062007

20072004200720052007200720072005

2007…

20072005200620062004200720062005

year

………

…

…

3.0

17.4…3.3

19.013.514.945.1

7.4

……2.8……

53.9……

12.723.2

7.017.710.518.5

7.5

5.96.62.0

13.62.0

…………………………2.0…………………………

…

…3.77.48.1

…

…

2.4

…1.94.83.72.23.93.54.3

…6.31.2……2.7…3.5

…4.23.42.22.34.4

3.6

…4.63.92.17.0

…4.32.98.53.44.33.73.83.25.63.17.1

11.52.13.73.63.82.54.82.33.0

…

…5.31.44.6

…

…

2.7

…1.53.23.94.82.94.12.0

……3.2……2.1……

…1.62.46.12.12.0

3.8

…3.22.12.93.1

…2.61.02.52.91.8…2.25.41.12.41.10.91.81.40.60.72.9………

cdd

ec,edddd

e,fg

f

df

ge

c,d

d,hd,h

c,e,h

e,feg

d

e

kd,ld,l

d,m

le,me,md,md,md,nd,m

g,m

m

d,mmmg,ne,l

d,m

d,md,mme,m

lle,me,lg,l

lkkd,mlllll

e,m

(a) estimated to be 11,116 USD or more; (b) estimated to be 906-3,595 USD; (c) institutional expenditure; (d) value 2006; (e) value 2005;(f) expenditure by activities or budgetary program (includes public health insurance); (g) value 2003; (h) includes 'Obras Sociales' (ARG), ISAPRES and FONASA (CHL), IAMC (URY);(k) personal care and health; (l) medical care and expense; (m) health; (n) health care and health conservation.

a

b

a

aaaa

a

a

immunization coverage


The Americas




Latin America

Mexico


Costa RicaEl Salvador*

GuatemalaHondurasNicaragua

Panama

Latin CaribbeanCuba


GuadeloupeHaiti


Andean AreaBolivia

ColombiaEcuador

PeruVenezuela

Brazil












11 12 13 14 15 16 17 19 20 22

DTP1

2007

DTP3<1 year of age

percentage of coverage

1 year of age

2007

Hib3

2007 2007

Hep B3BCG polio3

2007 2007

MMRinfluenza

DTP3 MMR

2007 2007 2007 2007

percentage of municipalitieswith coverage level ≥95%

total numberof districts/

municipalities

2007

2118

MMR2h

2007

(for olderadults)

96

NANANANA

96

96

99

979991

1009791

100100

84100

92……70

……

928693

100100

82

100

97100

987899

90100NA…NANA8490NA9787

100…97

100100NANA

10098

…

a,b

a

a

a

a

a

a

94

93949093

94

94

100

939789

1009386

10087

809986

……66

……

858293

1008767

100

9294957895

899598

…95939193

1009485

100100100

99100

84908083

…

cc

a,b

a

a

ad

a

96

9997

…99

95

95

100

959890

1009686

100100

82…87

……77

……

888591

100100

69

98

9394987899

90100100…100

93…9391968581

…100

95100

96909095

…

c,e

a,b

a

a

a

fa

93

95949495

93

93

98

939689

1009386

10088

809387

……68

……

848293

1008761

98

9496967895

88100

99…95939196

1009485

100100100

99100

84888095

…

cc,e

a,b

a

a

a

ad

a

91

92947093

91

91

98

939688

1009386

10088

459770

……NA……

848293

1008761

98

9496967895

87100100…95939193

1009485

100100100

99100

84888080

…

c

a,b

a

a

a

ad

a

89

87831493

90

90

98

939689

1009386

10088

499381

……NA……

848293

1008761

95

9192967895

88100

97…93937993

1009485

10086

10099

10084898019

…

c

a,b

a

a

a

ad

a

93

92899492

94

94

96

949690

1009389

10089

79100

96……54

……

858395

1009556

100

9599928097

84100

99…96758796989676

100829994

10085918771

…

cc

a,b

a

g

a

a

ad

a

57……

85

89…81NANANA80

100………NA……

NA93NA

9NA

49

919563

…

…78

…NA75

…95869017

100………83NA87

………

653765

85

NA…9249917894

…………NA……

NA…58NA21

90

85897331

………NANA………NA…80

…NA……NANA…NA…

k

e

……

66.7

56.1

56.1

94.2

43.466.724.732.858.733.258.840.3

21.95.9

29.0……

33.8……

30.222.627.7…

39.39.3

64.4

52.047.751.319.788.7

53.2…

50.0…

73.2………

28.646.2

7.7100…10010088.930.033.3100……

e

k

f

……7.8

59.2

59.3

89.2

40.150.025.915.357.238.362.727.3

56.010037.4……

21.8……

41.026.935.3…

55.810.9

64.8

52.045.444.127.596.0

47.9…

37.5……………

28.661.5

7.7100…100…

55.640.044.4100……

e

f

1 13 51

15,148

14,917

2,474

1,208 6

81 262 332 298 153

76

457 169 … … 133 … … 155

3,815 327

1,119 169

1,833 367

5,564

1,399 547 345 232 275

231 3

24 … 85

8 6 7 7

13 13

4 1

17 9 9

10 9 6

… …

klm

d

f

(a) reported coverage >100%; (b) coverage under revision by the country; (c) <2 years of age; (d) St. Maarten only; (e) value 2004; (f) value 2006; (g) coverage report for measles vaccine in children <1 year of age; (h) target age groups vary by country; (k) value 2005; (l) reports number of provinces and territories;(m) reports number of states.

immunization coverageThe Americas




Latin America

Mexico



Panama

Latin CaribbeanCuba


GuadeloupeHaiti


Andean AreaBolivia

ColombiaEcuador

PeruVenezuela

Brazil












23

neonataltetanus

24

2007

mumps

30 3331 32 34

200720072007 2007

number of reported cases

wild polio measles

2007 2007

confirmed casesrubella CRS

2007 2007 2007

tetanus (non-neonatal)

25

2007

male pertussis

26 27 28 29

female

2007

total diphtheriaHib

meningitis

0

0000

0

0

0

00000000

00000000

000000

0

00000

000000000000000000000

176

1440

10143

32

32

0

00000000

0000

…0

……

320000

32

0

00000

000

…00000000000000000

aa,b

a

13,193

1301

12

13,180

13,180

102

00000000

0000

…0

……

640200

62

8,683

4,33196

4,23500

000

…0000000000000000

…

b

c

c

19

0000

19

19

0

00000000

00

…0

…0

……

200020

17

00000

000

…0000000000000000

…

b

c

63

0000

63

63

4

20002000

4002

……38

……

1214241

5

00000

000

…0000000000000000

…

b

457

…………

457

446

40

220062

1121

920

52……40

……

5060

…43

1

228

143290

1100

…11001070

…0001

…00

…

154

0………

154

149

5

70101221

640

12……52

……

1530

…12

…

53

53110

500

…01000030

…0001

…00

…

723

3305

28

690

674

45

290163

1342

1560

64……92

……

1449

651555

…

281

1963

100

1600

…120010

10000002000

…

b

19,753

11,9260

1,47210,454

7,827

7,824

164

2,3230

2,0242

97715178

8340

10……824……

2560

1258447

…

596

3,6512,5871,030

826

300

…0000030000000000

…

b

103

5050

98

98

0

00000000

9804

……94

……

00000

…

0

00000

000

…0000000000000000

…

212

480

2622

164

162

1

50

…120

…2

330

……………

162

140

……

108

2917

282

200

…000100000010000

……

b,d

47,562

1,9080

1,108800

45,654

45,653

7,880

91200

3292

233141207

267267………………

21,423…

2,29411

…19,118

…

15,17111,575

1,387140

2,069

10

……

00100000000

………

00

…

b

(a) cases related to importation; (b) Morbidity and Mortality Weekly Report (MMWR), August 22, 2008/Vol 57/No.33; (c) provisional data; (d) invasive disease (age <5 years).

b

morbidity data

immunization coverageThe Americas




Latin America

Mexico



Panama

Latin CaribbeanCuba


GuadeloupeHaiti


Andean AreaBolivia

ColombiaEcuador

PeruVenezuela

Brazil












2007

spending on routineimmunization financed using

gov’t funds (%)

43

spending on vaccine purchases

financed usinggov’t funds (%)

budget line for vaccine purchases

2007 2007

number of NCIP

meetings

multi-year strategicplan for national

immunizationprogram

35 3736 38

2007 2007

39 40 41 42

2007 2007 2007

plan forimmunization

injectionsafety

national system

to monitor ESAVIs

number of ICC

meetings

2007

number of districts with at least1 supportive

supervisory visit

…100…

100

10010095

1009770

100

99100……10……

8710099

100100

100

100100100100

………10010010010010069

100……100100100100100………

…100…

100

10010010010010049

100

9994……0

……

100100100100100

100

100100100100

………100100100100100100100……100100100100100………

………

…

yesyesyesyesyesyesyes

yesyes……no……

yesyesyesyesyes

yes

yesyesyesyes

………yes……yesyesyesyes……yesyesyesyesyes………

noyesno

yes

yesno

yesno

yesyesyes

yesyes……yes……

yesyesno

yesno

yes

yesyesyesyes

nono

…yesnono

yesno

yesnonono

yesyesyesno

yes…no

…

NANANA

284

NAno ICC

3133

no ICC

23

……2

……

4120

no ICC

3

…no ICC

1no ICC

no ICCno ICC…

no ICC1

no ICCno ICCno ICC

20

no ICC2

no ICCno ICCno ICCno ICCno ICC………

333

9

NA9

100415

5no NCIP

……5

……

242

12…

3

220

no NCIP

no NCIPno NCIP

…no NCIPno NCIPno NCIPno NCIPno NCIPno NCIPno NCIPno NCIP

1no NCIPno NCIPno NCIPno NCIP

2………

…NANA

…

681

262…298……

169155……………

………850

0

5,564

…345232…

…24…240

…77

131340

1799

…8

………

…yesNA

yes

yesyesyesyesyesyesyes

yes………yes……

yesyesnoyesno

no

yesyesyesno

………yesnoyesyesyesyesyesnono…yesyesnoyes………

…yesNA

yes

noyesyesyesyesyesyes

yes………no……

yesyesyesyesyes

yes

yesyesyesyes

yesyes…yesyesyesyesyesyesyesyesnoyesyesyesnoyesno……

ab

c

d

e

d

d

a,e

a

d

d

d

d

d

d

d

d

a

d

d

d

d

dd

d

d

(a) value 2005; (b) value 2004; (c) created in 2007; (d) value 2006; (e) budget line is for medications and vaccines.

program management and financing


% of cases

discardedby lab

Acute Flaccid Paralysis (AFP), 2007

Number of AFP casesCountry

Country

AFP rateper 100,000

<15 years old

% cases investigated<48 hours

% with 1 sampletaken within

14 days of onset %

Measles/Rubella, 2007

ArgentinaBoliviaBrasil

CanadaCAREC

ChileColombia

Costa RicaCuba

Dominican Republic Ecuador

El SalvadorGuatemala

HaitiHonduras

MexicoNicaragua

PanamaParaguay

PeruUruguay

USAVenezuela

TOTAL/AVERAGE

13322

636334283

1493321173950851356

4852711209112…58

2,116

1.300.611.160.592.082.101.172.680.960.540.912.141.870.321.871.551.261.121.001.071.47

…0.70

1.23

869198…83827091

1005395988792

100989664909733…91

92

838276…43737767907679907877

100828982656550…81

78

937893...

1009988...

100827075...

839496

1009191...

65...

77

90

ArgentinaBoliviaBrazil

CanadaCAREC

ChileColombia

Costa RicaCuba

Dominican RepublicEcuador

El SalvadorFrench Guiana

GuadeloupeGuatemala

HaitiHonduras

MartiniqueMexico

NicaraguaPanama

ParaguayPeru

Puerto RicoUruguay

USAVenezuela

TOTAL/AVERAGE

897878...

999887...

97827081.........

8294...

95100

9191

100...

37...

78

88

289869...

74316657

100686351......

979797...

9977775996...

24...

88

72

859981...

97719792

100100

99100

...

...99

10096...

999999

10098...

75...

98

85

647644...

2573808095498888......

772985...

9278668894...

94...

66

58

847471...

95979075

100618184......

853598...

868894

10019...

72...

75

74

99100

95...

98859887

100100

9898......

9794

100...

9899999998...

90...

99

95

%

(a) provisional data; (b) also includes information on active case-searches.Source: Polio Eradication Surveillance System (PESS), Measles Elimination Surveillance Sysytem (MESS), and country reports, FCH-IM/PAHO.

% of cases withadequate

investigation

% of cases withadequatesamples

% samplesreceivedin lab

≤5 days

% labsamplesresults

≤4 days

b

b

a

a

a

Sites reportingweekly

242,0743,328

…487317

4,653...

25245984

11...

53242

15,749177234451

...3

…1,921

30,978

289151

37,687…

5074,2351,767

86621202544121

……

42631

224…

6,457169142399

2,838…21…

2,677

59,594

Numberof

suspectcases

252,086

10,199...

701533

4,476...

444251

1,04512......

83445

236...

14,517176238451

3,299...4

...2,561

42,133

Sites reportingweekly

Number

Number

surveillance indicators

Main Data SourcesDemographic data: United Nations Population Division. World Population Prospects: The 2006 Revision. New York; 2007. US Bureau of the Census. International Database: Update for countries/territories with populations under 100,000 inhabitants. Last accessed in May 2008 at http://www.census.gov/ipc/www/idbacc.html. Infant mortality rate (1,000 lb) or number of deaths (N): Reported or estimated by countries. Data are presented when the relative standard error is less than 23%; otherwise, the number of deaths is shown. An increase in infant mortality rate may reflect an improvement in data coverage and quality.Socioeconomic indicators: The World Bank. 2008 World Development Indicators. Washington DC; 2008. For national health expenditure data, Technical Reports from HSS/HP - WHO/PAHO Regional Unit; 2008.Immunization coverage, immunization program management, and financing information: Annual country reports to Comprehensive Family Immunization (IM)/PAHO via EPI tables PAHO-WHO/UNICEF Joint Reporting Form (JRF); 2008.Morbidity: Annual country reports to IM/PAHO via JRF, vaccine-preventable disease specific surveillance reports for measles/rubella and polio; 2007-2008.Surveillance indicators: Vaccine-preventable disease specific surveillance reports for measles/rubella and acute flaccid paralysis/polio to IM/PAHO; 2007-2008.

Symbols and Abbreviations… not availablepop population lb live birthsppp purchase power parityGDP gross domestic productint’l internationalBCG bacille Calmette-Guérin (anti-tuberculosis vaccine)NA not applicablePolio3 third dose of polio vaccine (oral polio vaccine or inactivated polio vaccine)DTP1 first dose of diphtheria-pertussis-tetanus vaccine (as DTP or combination vaccine)DTP3 third dose of diphtheria-pertussis-tetanus vaccine (as DTP

or combination vaccine)Hib3 third dose of Haemophilus influenzae type b (Hib) vaccine (as monovalent Hib or combination vaccine)Hep B3 third dose of hepatitis B vaccine (as monovalent hepatitis B or combination vaccine)MMR measles, mumps, rubella vaccineMMR2 second dose of measles, mumps, rubella vaccine (when offered in the routine program)CRS congenital rubella syndromeNNT neonatal tetanusHib Haemophilus influenzae type bICC interagency coordinating committee for immunizationNCIP national committee on immunization practicesESAVI event supposedly attributable to vaccination or immunizationgov’t governmentPentavalent combination vaccine DTP-Hib-Hepatitis Bm monthsy years

Technical NotesFor detailed information on demographic data and socioeconomic indicators, please visit: www.paho.org/English/dd/ais/coredata.htm. To see the methodology used to calculate national health expenditure, please visit: www.paho.org/Spanish/DPM/ SHD/HPnhexp-metodos.htm.

Immunization coverage: Proportion of children aged <1 year vaccinated with one dose of BCG vaccine, the third dose of polio vaccine (oral polio vaccine or inactivated polio vaccine), the first and third doses of DTP, and the third dose of Hib vaccine and hepatitis B vaccine, respectively. Proportion of children aged 1 year vaccinated with one dose of MMR vaccine. Proportion of children vaccinated with a second dose of MMR vaccine, as targeted in the countries routinely offering a second MMR dose. Proportion of older adults vaccinated with one dose of seasonal influenza vaccine, as targeted in the countries routinely offering this vaccine. Coverage rates are expressed as a percentage of the corresponding mid-year population, as reported by the country. Reported coverage rates ≥100% are presented as 99%. Subregional aggregated data express average values weighted by population aged <1 year, when a figure is available.

Selected Information Products of the Comprehensive Family Immunization

•Immunization Newsletter: A bi-monthly publication that includes information on all aspects of program implementation, from scientific articles on vaccine-preventable diseases and vaccines to practical matters related to the day-to-day running of an immunization program.

•Rubella Watch: Supplement to the Immunization Newsletter providing the most up-to-date information on all aspects of the rubella and CRS elimination initiative being implemented in the Americas.

•Measles/Rubella and Polio Bulletins: Weekly epidemiological surveillance bulletins.•Immunization Field Guides: Seven practical field guides presenting the most recent techniques, coupled with useful

illustrations, to help health workers in their efforts to control, eliminate, or eradicate diseases such as poliomyelitis, measles, rubella, yellow fever, neonatal tetanus, diphtheria, tetanus, pertussis, Haemophilus influenzae type b, hepatitis B, and rotavirus.

•Safe Vaccination Training Modules: Designed to give health workers the information they need to guarantee the use of quality vaccines, safe injections, and the monitoring of ESAVIs and to address public concerns regarding the potential risks of vaccines and adverse events following vaccination.

•Recent Advances in Immunization: The second edition (2006) of this publication deals with the most relevant topics that countries face in trying to deliver high-quality immunization services.

Please visit the Comprehensive Family Immunization page at www.paho.org/immunization

technical notes and data sources


Municipalities reaching coverage ≥95% for DTP3 and MMR: Proportion of municipalities reporting coverage levels equal to or greater than 95% for DTP3 and MMR1 vaccines, respectively, expressed as a percentage. Municipalities are defined as the third administrative level (country level being first), unless otherwise stated.

Morbidity: Number of reported cases of wild polio, confirmed measles, confirmed rubella, confirmed CRS, NNT, non-NNT, pertussis, diphtheria, Hib meningitis, and mumps. Subregional aggregated data is the sum of the totals. These are not rates; hence, inter-country comparisons may not be appropriate.

Immunization program management and financing: • Multi-year strategic plan: Written strategic plan regarding the immunization program and its activities for multiple years, usually covering 5 years.• ICC meetings: ICCs channel efforts by international agencies, governments, and the civil society to help countries strengthen their immunization programs and control vaccine-preventable diseases. ICCs are charged with the task of ensuring coordination of all inter-agency inputs.• NCIP meetings: NCIPs provide recommendations on immunization practices, including advice on vaccines to be included into the national immunization schedule. • Number of districts with at least one supervisory visit: immunization supervision including all or most aspects of the program to the local level, generally by region/department/state or national level.• Plan for immunization injection safety: the existence of a plan to ensure the safety of injections, including training, supervision, the proper use of

safety boxes, etc. This plan may be part of the annual immunization plan of action. • National system to monitor ESAVIs: System in place for the reporting and follow-up of ESAVIs.•Spending on routine immunization financed using government funds: Percentage of all of recurrent immunization-specific spending that was financed using government funds (for all recurrent inputs including vaccines, injection supplies, salaries and per-diems of health staff working full-time on immunization, transport, vehicles and cold chain maintenance, training, social mobilization, monitoring, and surveillance). This excludes any external financing from donors, but may include loans.•Spending on vaccine purchases financed using government funds: Percentage of all vaccine spending that was financed using government funds. This excludes any external financing from donors, but may include loans.•Budget line for vaccine purchase: Specific line in the national budget for the purchase of vaccines.

Surveillance indicators: For measles/rubella definitions refer to PAHO. Measles Elimination: Field Guide. (Scientific and Technical Publication No. 605). Washington DC: PAHO, 2005. For acute flaccid paralysis definitions refer to PAHO. Poliomyelitis Eradication: Field Guide. (Scientific and Technical Publication No. 607). Washington DC: PAHO, 2005. Available at www.paho.org/english/ad/fch/im/FieldGuide_Index.htm.

This brochure is published in collaboration with Health Information and Analysis, Pan American Health Organization.

Towards Rubella and CRS Elimination in the AmericasAdolescent and Adult Vaccination Campaigns, 1998-2008

Millio

ns Va

ccina

ted

(a) rubella only; (b) women; (c) men.Source: Country reports to FCH-IM/PAHO.

BRA 2008

CAR 1998-2001

CHI 1999 (a,

b)

COR 2001

BRA 2000-2002

ELS 2004

ECU 2004

HON 2002

COL 2005

PAR 2005

VEN 2005

NIC 2005

ARG 2006 (b)

BOL 2006

MEX 2006

BOL 2007

GUT 2007

CUB 2007

PER 2006

DOR 2006

VEN 2007

CHI 2007

ARG 2008 (c)

HAI 2007-2008

MEX 2008

20

0

60

40

100

80

140

120

160

200

180

240

220

260

Country Accumulated

At the conclusion of 2008, more than 250 millionmen and women will have been vaccinated in

campaigns against rubella and measles


Measles Genotypes in Latin Americaand the Caribbean, 1999-2007

Source: Measles Strain Bank, Centers for Disease Control and Prevention (CDC).

2005: D9, Mexico from US?2003-2004: H1, Mexico from China

1999, 2001: D7, El Salvador from Europe

1999, 2000: D6, Bolivia

2003: H1, Chile from Japan

2005-2006: B3, Mexico from US?

1999, 2000: D6, Haiti and Dominican Republic

2001-2002: D9, Venezuela, Colombia2006: B3, Venezuela from Spain

2007: B3, Venezuela (until February 2007)

2001: D5, Brazil from Japan2005: D5, Brazil from Maldives

2006-2007: D4, Brazil from Poland

Summary of Yellow Fever Vaccination in Countrieswith Areas at Risk, the Americas, 2007-2008

Routine Schedule

Vaccination in the Routine Childhood Schedule (<2 Years)Country

Source: Country reports through the PAHO-WHO/UNICEF Joint Reporting Forms (JRF), 2007 and to FCH-IM/PAHO.(a) reported coverage >100%.

National/Sub-national Coverage

Other Interventions(≥2 years)

Argentina

Bolivia

Brazil

Colombia

Ecuador

French Guiana

Guyana

Panama

Paraguay

Peru

Suriname

Trinidad & Tobago

Venezuela

1 year

12-23 months

9 months

12-23 months

12-23 months

1 year

1 year

1 year

1 year

1 year

1 year

1 year

1 year

Northern Municipalities at Risk

National

Municipalities at Risk

National

Amazon Region

National

National

Areas at Risk

National (Sub-national Before 2007)

National

Hinterland

National

Areas at Risk

…

82%

100%a

84%

90%

…

96%

80%

34%

87%

83%

90%

58%

Vaccination campaigns in areas at risk, 2008

National Vaccination campaign, 2007

Vaccination campaigns in areas at risk



…

NA

NA


Mass campaigns since 2004 startingin areas at higher risk

NA

NA



Source: Country Reports to Rotavirus Database, FCH-IM/PAHO.

Number of hospi-talizations in children

aged <5 years

n n nnn % % % %

Data and Indicators of Rotavirus Sentinel Hospital-based Surveillancein Reporting Countries, The Americas, 2007

DATA and INDICATORS

Number of hospitalizationsdue to diarrhea in

children aged <5 years

Number of children aged<5 years that meet the case definition

Number of children with complete form and stool

sample collected

Number of cases with result

positive for rotavirus

Bolivia

Chile

El Salvador

Guatemala

Guyana

Honduras

Nicaragua

Paraguay

St. Vincent

Suriname

Venezuela

11,121

21,880

32,311

18,434

561

44,628

12,284

5,690

403

697

13,002

2,097

2,074

5,942

3,674

52

5,463

2,278

500

81

127

1,366

18.9

9.5

18.4

19.9

9.3

12.2

18.5

8.8

20.1

18.2

10.5

1,756

1,077

3,188

1,772

. . .

5,326

1,577

323

81

127

696

83.7

51.9

53.7

48.2

. . .

97.5

69.2

64.6

100

100

51.0

1,548

1,077

2,927

1,483

47

2,665

829

258

61

105

696

88.2

100

91.8

83.7

. . .

50.0

52.6

79.9

75.3

82.7

100

629

323

1,144

630

12

1,080

80

111

24

17

183

40.6

30.0

39.1

42.5

25.5

40.5

9.7

43.0

39.3

16.2

26.3

Bacterial Pneumonias and Bacterial Meningitis

Source: Country reports to FCH-IM/PAHO.

Number of Confirmed BacterialMeningitis Cases With Isolation: 632

Number of Confirmed BacterialPneumonias With Isolation: 129

Sentinel Hospital Surveillance of Bacterial Pneumonias in Children Aged Under 5 Years, Selected Countries

Region of the Americas, 2007

Sentinel Hospital Surveillance of Bacterial Meningitisin Children Aged Under 5 Years Selected Countries

Region of the Americas, 2007

BrazilEcuador

El SalvadorHondurasParaguay

Non-b Haemophilusinfluenzae

2.33%Streptococcus pneumoniae

33.33%

Other Bacterial 64.34%

Haemophilusinfluenzae type b

5.42%Neisseria

meningitidis46.61%

Streptococcuspneumoniae

46.61%Other Bacterial1.36%

immunization coverageRegional Laboratory Network

Quality Control of Syringes

Source: FCH-IM/PAHO.

Countries with laboratory in organization process

ECRI Regional reference laboratory

ECRI Institute is a nonprofit organization dedicated to draw on the discipline of applied scientific research to determine the best medical procedures, devices, drugs, and processes, and improve patient care. ECRI Institute is a center for health technologies engaged in the areas of consulting, research, analysis, and training. It serves as an information repository and a laboratory for the evaluation of medical devices.

Regional Laboratory NetworkQuality Control of Syringes

Source: FCH-IM/PAHO.

Countries with laboratory in organization process

ECRI Regional reference laboratory

ECRI Institute is a nonprofit organization dedicated to draw on the discipline of applied scientific research to determine the best medical procedures, devices, drugs, and processes, and improve patient care. ECRI Institute is a center for health technologies engaged in the areas of consulting, research, analysis, and training. It serves as an information repository and a laboratory for the evaluation of medical devices.

Source: FCH-IM/PAHO.* See Immunization Newsletter, Vol.XXVIII, Number 5 www.paho.org/english/ad/fch/im/sne2805.pdf

Pro-Vac is a multiyear project for the promotion of evidence-based policy decisions for new vaccine introduction in Latin America and the Caribbean.*

Country

Pro-Vac Work Plan

Vaccine(s)Subregion

CountryActivityPlanned

CountryActivities

Committed

RegionalActivity

Committed

Cuba

Guyana

Bolivia

Jamaica

Nicaragua

Honduras

Paraguay

Economic Workshop for GAVI-eligible countries

Brazil

E-learning Module developmentEconomics of Human Papillomavirus Workshop

Key center Network Development

RegionalActivityPlanned

Southern Cone

Southern Cone

PneumococcusRotavirus

Human Papillomavirus

Pneumococcus

Caribbean

Caribbean

Andean

Caribbean

Central America

Central America

Pneumococcus



Pneumococcus


Pneumococcus


Documents

Immunization in the Americas...levels >95% for all childhood vaccines in all municipalities. 2. Addressing the unfinished immunization agenda. First, coverage levels are not homogenous