A recent article in Science authored by Michael Mina and colleagues concludes that measles infection reduces antibodies that provide protection against infections thereby reducing the benefits of prior vaccination (https://science.sciencemag.org/content/366/6465/599). Measles vaccination acts as an essential complement to other vaccines; hence, defining system strength by DTP3 or MCV1 coverage appears inadequate. Because coverage can also be seen as a probability, it is possible to multiply DTP3 and MCV1 coverage to obtain the probability that an infant has received both. With this joint coverage approach, there is still a reassuringly high number of countries where coverage exceeds 90%. However, not surprisingly, there are about twice as many countries with coverage less than 70% using the joint methodology than through the use of either DTP3 or MCV1. The use of a joint coverage approach may be better at identifying weaknesses and fragility in immunization systems.

Dear Members of TechNet-21,   Do national coverage estimates affect your work? Do you use estimates to make decisions? Are you interested in contributing to their improvement? If you have answered yes to any of these questions we would love to hear what you have to say about this important indicator.   Supported by WHO and UNICEF, Swiss TPH are conducting a study to explore: 1. the use and usefulness of estimates for decision making, and 2. methodological approaches to improve estimates of national immunization coverage.   Please find attached the WHO/UNICEF WUENIC project introduction letter which includes further details and the link to the online survey (15 minutes). You can also access the survey directly here: https://forms.gle/9dUMZb1zABRdbkmb8   Many thanks for your interest and support, Caitlin & the Swiss TPH study team  

Dear viewers, A merry Christmas and a Happy new year 2019! On Christmas Eve of 2012, we shared the first write up on Immunogram as “Xmas gift”. Today, 6 years later, we wish to share it again because it can potentially achieve and sustain ≥90% Full Immunization Coverage (FIC) below one year and booster between 16 & 24 months as a package - see the attached one pager. Hope governments and other stakeholders will take up the success story for replication in a wider area. best wishes n happy reading

New materials are available on the "Coverage Surveys" page of TechNet-21 (https://www.technet-21.org/en/topics/vaccination-coverage-surveys) on the "17 Steps to do a Coverage Survey". This collection contains a series of documents & presentations outlining the basic steps of a vaccination coverage survey, as well as some presentations on commonly asked questions and variations on a coverage survey. This also contains links to resources (templates, models, examples, etc). This link takes you to the drop box folder with all the materials. https://www.dropbox.com/sh/96ho3ta1l2qo65s/AAAAcmmNryuBksMk7o5mcLEza?dl=0

A textbook from lectures we used to give at the “Ciro de Quadros Vaccinology Course for Latin America” just got published by the Sabin Institute: https://www.sabin.org/programs/training-education/vaccinology-book. The book is available in English and Spanish. My chapter on information systems for EPI (part of section 3) is attached.

New article on "Global Routine Vaccination Coverage - 2017" was recently published in the CDC MMWR. Article can be accessed here: https://www.cdc.gov/mmwr/volumes/67/wr/mm6745a2.htm?s_cid=mm6745a2_e

Dear viewers, As announced earlier in August 2018, the author with the help of his team could realize his dream and celebrated “EuVac Baby Award Ceremony” today in KVG Medical College Hospital. Dr KV Chidananda, Medical Director, iterated that parents have very crucial role in getting their children vaccinated timely and completely. Many parents are vaccinating their children more close to the schedule than in the previous decades. This is a welcome step, depicting more awareness among the beneficiaries. He profusley thanked Dr Subramanya Taluk, Health Officer, and Dr Bhanumathi, AMO of CHC Sullia, all the Jr Health Assistants female, AWWs, ASHAs from the Government who brought the eligible beneficiaries from their respective area for the celebration and made it more jubilant. He congratulated all the parents. He felicitated the Vaccination team of the college providing world class services and supporting the government in implementing RI programme. All the three attached PHCs will cross 90% vaccination coverage before 2018, and the college will help in sustaining the high coverage.  Parents were greeted with warmth, they were provided a small gift (a tumbler and a spoon), and a certificate of appreciation. Laasya - the Indexed baby - was specially honored.  Please find the attached one page depicting the glimpses of the celebration with photos. We heartily wish you a happy reading. Holla and the team      

Dear esteemed viewers, ANM Mrs Chandrakala KM, AWW Mrs Indiravathi and ASHA Mrs Saraswathi K are the 3 ‘A’ces working in Health Sub-Centre Baddadka of planning unit Aranathodu of Sullia Block of Dakshinakannada District, Karnataka State, India. The entire planning unit – PHC Aranthodu will cross >90% coverage including booster dose by 2018 itself. The attached one page write-up describes a very rare event, though not uncommon in RI programmes hence thought of sharing with the viewers on this occasion of World Immunization Day. It is possible only through the simplest tool and a unique approach.  We hope all of you will enjoy the reading. Best wishes, KVG Team  

Dear esteemed viewers On the eve of Karnataka State Raising day (Kannada Rajyotsva), KVG team wishes to share the attached for caring the children of Karnataka and beyond. India is committed: - baby Rukhsar was the last case of Poliomyelitis due to wild polio virus in Jan 2011, - it got the certification of Polio Eradication in March 2014 for which entire world congratulated the country. Karnataka is even more committed, and had the last case of polio due to wild virus in Nov 2007. Sustenance of Polio free status till Global eradication is also extremely important through attaining and sustaining very high routine immunization coverage - that's the 1st strategy of polio eradication. WHO experts say that as long as a single child remains infected in the world, children in all countries are at risk of contracting polio. Failure to eradicate polio from the last remaining strongholds could result in as many as 200,000 new cases every year within 10 years all over the world.  Legacy: When immunization coverage in Syria with a population of ~18.3 million, dropped from 91% in 2010 to 68% in 2012, amounting to 500,000 susceptible children in absolute numbers in 2013; fresh polio cases occurred inspite of remaining polio free since 1999. Currently, RI coverage of the country and Karnataka is 62 & 63% respectively as per NFHS 2015-16. In Karnataka, the immunization coverage is ranging from as low as ~41% to 77% among 30 districts. Compared to Syria, it is critically low favoring importation of wild polio virus at any time. IPV is in use, but the coverage of which is much lower than OPV; National IPV2 coverage is 54% and 28% for Karnataka as per ITSU dashboard Indicators for the year 2017-18. In 2017, population of India was 1.339 billion and Karnataka was 66.8 millions, 3.65 times larger than Syria. Hence, on war foot we have to raise immunization coverage to >90% and sustain the same forever. In this context, we wish to share what we are doing in our Medical College which can rapidly close population immunity gap, vaccinate close to the schedule and sustain the same forever. I thank Drs Niranjan & Nirajan, Interns posted in the Rural PHC for giving the title “Sharing for Caring”. Wish you happy reading and replication Holla & Team         

Dear viewers, Greetings from KVG team. India launched Mission Indradhanush on 25th Dec 2014 to achieve >90% full immunization coverage (FIC) by 2020; it was intensified in October 2017 and the timeline was advanced to 2018 by the Honorable Prime Minister of India -- a silver line in the RI programme. We had an internal departmental discussion on the duelist of 12 HSCs of recently attached Primary Health Centre (PHC) who have completed 2 rounds of Intensified Mission Indradhanush (IMI) in Aug and Sep 2017. Delay in achieving the objectives by any country will affect Global achievement. Currently, at the global level there is serious concern about the quality, quantity, sensitivity, specificity, validity of the data, especially denominator / numerator / specific duelist / simplicity with which these can be obtained / how important it is in decision making / at what level and how quickly the right decision can be taken and timely executed etc. The attached true illustrations tilted as “Sunday – Longer than Monday” easily explain the situations. We are working together with 3 attached PHCs of the government on academic interest and social service to facilitate the service providers in attaining the objectives timely and sustain forever. 3 ‘D’s Affect: Duelist: the Determinant of Denominator" that was shared long back is very much relevant for understanding the intricate mechanism in the field, and is also attached for ease of reference. We wish you all a happy reading though it is a bit long. KVG Team

The WHO Immunization Monitoring Academy is a learning and capacity-building initiative. The Academy is open to all immunization professionals with an interest in the use, collection, and improvement of immunization data. Starting in Fall 2018, the Academy will offer a WHO Scholar certificate programme to support competency development in national and sub-national staff. The Academy will offer:  Level 1 certificate course in developing a Data Improvement Plan (DIP) in both English and French. A series of workshops on key topics for immunization monitoring. WHO Survey Scholar modules in French. In 2019, the Academy will offer Level 2 certification, focusing on implementation of a Data Improvement Plan. To learn more see the Academy's information page: http://learning.foundation/ima-level1-en/?utm_source=WHO+Scholar+network+(English)&utm_campaign=e9e7e0da24-EMAIL_CAMPAIGN_2018_05_28_05_22_COPY_01&utm_medium=email&utm_term=0_55bba48b4a-e9e7e0da24-260659585

Innovative solutions are not limited to products, drugs, or diagnostics. They include novel approaches and applications of a technology, service, or intervention to help countries advance their reproductive, maternal, newborn, child and adolescent health and development targets. As the immunization and child health technical lead for USAID’s flagship Maternal and Child Survival Project (MCSP), JSI supports the expansion of the evidence base for approaches and facilitates locally owned and context-sensitive adaptation of life-saving innovations. Learn more about how JSI’s MCSP team is advancing immunization programs below or download the most recent MCSP ‘Innovations Takeover’ newsletter.

The WHO website was updated with the most up to data WHO/UNICEF JRF data. The main launching page for this data is accessible from: http://www.who.int/immunization/monitoring_surveillance/data/en/ . From there you will be able to access: Country Profiles: http://apps.who.int/immunization_monitoring/globalsummary that include some charts and graphs; Regional and Global Summaries (from points 1 and 2 of the page); Disease incidence data in html or excel format; Immunization coverage data: Country official estimates, administrative data, HPV administered dose per age range,….; Immunization system indicators in html or excel format; And immunization schedule data: http://apps.who.int/immunization_monitoring/globalsummary/schedules. For those of you that have the immunization app on their devices, you may have noticed that the data was updated as well. For those that want to download it, instructions and tutorials are available from: http://www.who.int/immunization/monitoring_surveillance/en/. Comments, feedback and suggestions are welcomed to vpdata@who.int. The JRF Team

Dear colleagues,  The results of external evaluations assessing MyChild Solution based on Smart Paper Technology in Afghanistan are now available. These evaluations assessed the data quality, operational costs, efficiency gains as well as transfer of work processes to the existing health system in Afghanistan. In 2015, the Shifo Foundation, the Swedish Committee for Afghanistan (SCA), IKEA Foundation, and the Ministry of Public Health (MoPH) in Afghanistan started a joint collaboration to strengthen child health services in Afghanistan. Data and information are fundamental to inform decisions and assist key stakeholders to allocate appropriate resources to continuously improve the quality of health services. Therefore, one of the main objectives of the collaboration was to strengthen the quality of data and its utilisation in the Expanded Programme on Immunisation using an innovation based on Smart Paper Technology called MyChild Solution. MyChild Solution is an innovation developed by Shifo Foundation based on Smart Paper Technology. The solution was implemented and evaluated to inform evidence-based decisions on the scale up of the programme. MyChild Solution was implemented in 141 health service delivery points including fixed, outreached, and mobile clinics in the Mehterlam District of Laghman Province in Afghanistan. Currently, using MyChild Solution, more than 45,000 children have been registered, more than 9,000 children are fully vaccinated and more than 11,000 children are being followed up with SMS messages which inform parents about vaccination schedules. From the beginning of the programme, project stakeholders set several programme key success indicators which informed project development and external evaluations. These success indicators measured data quality such as completeness of data, timeliness, internal consistency, and external consistency and analysed if MyChild Solution could be integrated into the existing health system, thus sustained by the government. In June 2018, two external evaluations were conducted to assess data quality, operational costs, and efficiency gains as well as the transfer of work processes to the existing health system. This article summarises the results of these external evaluation reports. The data quality and review toolkit developed by World Health Organisation was used to evaluate the quality of data generated by MyChild Solution. The assessment showed high-quality data generated from MyChild Solution in every indicator, including completeness (100%), timeliness (91,66%), internal consistency (100%), and external consistency (99,4%). Moreover, the ratio of data recording error was low in the study and ranged from 0.05% to 1.7% for two selected data recording errors. The second evaluation investigated time efficiency. This evaluation assessed the time health workers spent on administrative tasks during and after delivery of care with MyChild Solution and compared the results with existing Health Management Information System(HMIS) tools. Results showed that 64% to 96% of time spent on administration could be reduced with MyChild Solution when compared to the current HMIS. Incremental cost analysis was done considering two scenarios. The first scenario took into account the monetary value of the reduced time for administration whereas the second scenario was conducted without the time reduction values. The evaluation also took into account two versions of the MyChild Solution. The first evaluation assessed MyChild Forms which is an innovation on facility-based data management tools. The second evaluation assessed MyChild Card which is an innovation modelled after the child health card. When adding the value of the reduced administration time, the total national cost of MyChild Card was 611,974 USD and the total national cost of MyChild Forms was 316,436 USD. Comparatively, the existing HMIS total national cost was 873,253 USD. Over a five-year period, MyChild Forms would save around 2,938,543 USD and MyChild Card would save around 1,378,875 USD compared to the existing HMIS system. When administration time is removed from the analysis, MyChild Card (501,622 USD) and MyChild Forms (206,126 USD) amounted to be more costly than HMIS forms (195,581 USD). It is noteworthy that when administration time is excluded from the analysis, MyChild Forms were 5% more expensive than HMIS. The second report displayed the results of the transfer of work processes to the existing health system. This is one of the key elements to evaluate the sustainability of the programme as well as how successful management was by the local stakeholders in Afghanistan. The results indicate that 95% of the processes essential to the management of MyChild Solution had been transferred to the local stakeholders in Mehterlam District. In most cases, these processes had been transferred in a way that is both accurate and sustainable. The remaining 5% of processes are planned to be fully transferred to Mehterlam by the end of 2018 to increase process accuracy. The external evaluation reports provide information on the effects of MyChild Solution from four different perspectives which give valuable insights to key stakeholders. These perspectives are data quality, costs, efficiency gains and transfer of work processes to the local level. Based on the findings derived from these external evaluations Shifo, SCA, and MoPH will collaborate to further expand and investigate the intervention on a larger level to inform decision making for the national implementation of the programme. The programme positively addressed all the key success metrics set in 2015 and brings opportunities to empower health and social workers at all levels of healthcare delivery who continuously work to improve quality of child health services across the country based on the reliable and relevant information. The full reports and additional information about MyChild Solution can be accessed using these links below: 1) Questing The MyChild Solution in Afghanistan- An external evaluation of Data Quality, Operational Cost and Efficiency: https://shifo.org/doc/rmnch/MyChildExternalEvaluationAfghanistan2018.pdf 2) MyChild Solution in Afghanistan: An External Evaluation — Transfer of Work Processes to Existing Health System: https://shifo.org/doc/rmnch/ShifoExternalEvaluationTransferProcessAfghanistan.pdf 3) About MyChild Solution based on Smart Paper Technology: https://shifo.org/en/solution/ 4) Project progress in Afghanistan: https://shifo.org/en/work/afghanistan/ 5) Link to the summary of the reports: https://medium.com/shifo-news/external-evaluation-results-313c92ddcb88    Looking forward to your follow up questions/discussions. Kind regards, Nargis  

During the GIM conducted in Rwanda in June 2018, a breakout session entitled “Innovations & Transitions for Immunization Data” was moderated by Jan Grevendonk, WHO HQ, and Hope Johnson, The Gavi Alliance.  Participants discussed the transitions that are taking place with immunization data, such as the move from parallel to integrated systems, aggregate data to individual record keeping, infant to life course vaccination, systems and tools moving from paper to cloud, and the need to move from data for reporting to data for action. They heard from several country and regional experiences and innovations: George Bonsu (Ghana EPI), talked about how Ghana integrated the DVMT EPI reporting systems into the national HMIS (DHIMS). Alain Poy (WHO/AFRO) presented the routine immunization module within DHIS2, which was developed by WHO and the University of Oslo, and is now being implemented in countries in the African Region. Josephine Simwinga (Zambia EPI) shared her experiences with the implementation of electronic systems for logistics and immunization registries. Martha Velandia (PAHO) talked about the progress and lessons learned with Electronic Immunization Registries in the region. Emma Hannay (Acasus) showed how EPI in Punjab (Pakistan) increased accountability through the use of a mobile app for health workers. Lora Shimp (JSI) highlighted the continued importance of paper records and tools as she presented on data quality and use at the facility level. Laurie Werner (PATH) evaluated the evidence behind data interventions, as found by the IDEA project. Presentations from the Data Session at the GIM Meeting 2018 can be found here: https://www.technet-21.org/en/library/main/4913

You will find in the TechNet-21 Resource Library the recently released WHO report "Explorations of Inequality: Childhood Immunization"  and its accompanying interactive data visuals: https://www.technet-21.org/en/library/main/4912-explorations-of-inequality-childhood-immunization The report describes how children’s likelihood of being vaccinated is affected by socioeconomic, demographic and geographic factors and how the ones who benefit from multiple forms of advantage are more likely to be vaccinated than children who experience a single type of advantage. The report is based on international household health surveys conducted in the following 10 countries:  Afghanistan, Chad, DRC, Ethiopia, India, Indonesia, Kenya, Nigeria, Pakistan and Uganda. Together they account for more than 70% of children who do not get a full course of basic vaccines. Short excerpt below. If you have limited time, I strongly recommend you read Chapter 13 on the multi-country assessments, which is quite rich and provides an excellent cross-sectional analysis.   "Despite the uniqueness of each country situation, some commonalities emerged. Inequalities by child’s sex tended to be minimal or non-existent, and inequality by subnational region tended to be substantial. All countries reported variation by mother’s education and subnational region and all (except Uganda) demonstrated inequality on the basis of household economic status. All 10 priority countries showed a positive association between mother’s education level and childhood immunization coverage. Countries that reported low national coverage (e.g. Chad, Ethiopia and Nigeria) tended to demonstrate steep gradients and/or mass deprivation patterns across socioeconomic subgroups; the odds of immunization tended to be significantly higher in more advantaged subgroups in these countries. Countries with higher national coverage (e.g. India, Indonesia, Kenya and Uganda), more often demonstrated marginal exclusion or universal patterns across socioeconomic subgroups,and tended to have lower urban–rural inequality. When considered alongside knowledge of the country context, the results of this report can be used to inform equity-oriented policies, programmes and practices to promote universal childhood immunization coverage. This report serves as a basis for more detailed explorations at the national and subnational levels, and a baseline for future health inequality monitoring efforts. Monitoring and exploring inequalities in health is essential as countries strive to “leave no one behind” on the path towards sustainable development." The accompanying web story (top story on the WHO page for now) announcing the release of the report is accessible here: http://www.who.int/gho/health_equity/explorations-of-inequality-childhood-immunization Link to the report landing page: http://www.who.int/gho/health_equity/report_2018_immunization/en/  

WHO would like to announce that the new WHO Vaccination Coverage Cluster Surveys Reference Manual is available on the Technet website on the Coverage Surveys page. This document can be downloaded from here: https://www.technet-21.org/en/topics/vaccination-coverage-surveys under the section on "Current WHO reference manuals"      

Empower is organizing the third International Workshop and Study Tour on Ensuring Universal Health Coverage by Promoting Access to Life-Saving Medicines in Geneva, Switzerland scheduled from 20th to 24th August 2018. It’s a 5-day workshop and our participants will be public health professionals, program officers, supply chain professionals from various Ministries of Health, UN agencies, donor agencies, private and civil society organizations. The Key Topics to be covered during the workshop are Universal Health Coverage, Access to Medicines, Key Components of PSM, Supply Chain - Levels of Maturity, Quality Assurance, and Regulatory Sciences. This workshop will share with the participants how leading global health stakeholders are supporting the Universal Health Coverage agenda with the focus on access to essential medicines. The overall objectives of the Workshop are: Interact with and learn from global health leaders from WHO, Global Fund, UNDP, Red Cross, GAVI, Stop TB and many more. Recognize the role and structure of leading global health organizations in promoting Universal Health Coverage Identify the key concepts of access to medicines and relationship with Universal Health Coverage Learn about improvements and innovation in access to new medicines Achieve personal growth in terms of leadership and management skills linked with global policies translated into local actions This workshop is targeted at professionals in public health programs (donors, government, the private sector, NGOs, civil society, academia) and people interested in global health procurement and supply chain/logistics and universal health coverage.  Course fees: US$ 2500 which includes: One week face-to-face training in Geneva + two weeks preparatory work Certificate from Empower Swiss Local transportation for field visits Technical assistance for one year Does not include – international travel, airport transfers, food and accommodation   To apply, please Click Here Registration deadline: 5th August 2018 Please feel free to contact us for any further queries or information - training@empowerschoolofhealth.org

PAHO is pleased to introduce a new resource publication that contains a set of modules aimed at improving the monitoring of coverage of integrated public health interventions.  To improve the well-being of the population and bridge gaps in health service delivery, it is necessary to guarantee access to various health interventions, including proven strategies such as vaccination and deworming. Meeting program coverage goals, however, depends on identifying and reaching target populations.This means, in turn, promoting universal access to health using integrated approaches and a more efficient use of resources. What’s more, health services must adopt monitoring and systematic analysis of coverage as indispensable activities. Immunization programs in the Americas have extensive experience with the methodologies and tools for monitoring vaccination coverage. Countries have adopted and improved these instruments, adapting them to a range of target populations and epidemiological contexts. Moreover, the accumulative experience gained in the area of vaccine-preventable diseases (VPDs) may be applied to other programs, like deworming, which uses very effective interventions to reduce the burden of disease caused by soil-transmitted helminths. Registries that generate data on administrative coverage are very useful for helping to control, monitor, and evaluate program evaluation. But the quality of numerators and denominators can affect the quality of coverage data. It is thus important to analyze and interpret administrative coverage indicators correctly, supplementing them with other field methodologies that health teams can use to monitor and evaluate health interventions. The Pan American Health Organization’s (PAHO) Comprehensive Family Immunization Unit and Regional Program on Neglected Infectious Diseases (NIDs) have highlighted the need to systematize and integrate methods for monitoring coverage of health interventions among preschool- and school-age populations and are offering strategies and opportunities for collaboration. Publication is also available in Spanish  

"There is no arguing that aggregate data is useful, but as with most things, it has its limitations."   Read the full article (5 minutes) here: https://medium.com/shifo-news/going-beyond-the-aggregated-why-we-have-better-knowledge-on-immunisation-dropouts-with-individual-efc8e11cf879     

Dear Colleagues and partners I hope you’re well and that 2018 has got off to a great start!    I hope you don’t mind me reaching out to request your help is spreading the word about INFUSE within your networks. Innovation for Uptake, Scale and Equity in Immunisation, or INFUSE for short, is an acceleration platform to identify proven solutions which, when scaled up, have the greatest potential to modernise global health and immunisation delivery. Each year, INFUSE calls for innovations that can help Gavi, governments, and partners reach more children with life-saving vaccines. INFUSE then works with expert partners of the Alliance to select the most promising innovations and ‘infuse’ them with the capital, expertise, and other support needed to scale them up.  INFUSE 2018 is calling for proven digital technology innovations – adapted to low-resource environments in developing countries – to help identify and register children, especially girls, who are at risk of missing out on life-saving vaccines. The innovations should greatly enhance the efficacy of immunisation delivery, and modernise methods to identify and register the children who most need life-saving vaccines and who currently are being missed by existing processes. All innovations that leverage technology to address equity challenges, help reach and protect the under-immunised – whether low-tech or high-tech, whether addressing supply or demand issues – are welcome. Please note that proposals must have advanced beyond the pilot stage and be capable of being deployed at a large scale within 6 to 12 months. We are not seeking research or pilot projects.  The deadline is 10 April 2018. For organisations interested in submitting an innovation for consideration and for more details on selection criteria and the annual INFUSE process please visit our website.  Please find attached the call for innovation –please spread the word among your networks and help us attract the most innovative solutions addressing the immunisation equity gap.  If you could kindly copy in infuse@gavi.org in your outreach ( if appropriate) that would be most appreciated! And if there are any questions, please do not hesitate to contact me and I can redirect your queries to the right desk. Thanks in advance for your support Best, Magloire ACHIDI + 41 22 909 65 46 Senior Supply Chain Consultant  | HSIS | RMPSP | STEP Program Manager machidi-external-consultant@gavi.org   2, Chemin des Mines, 1202 Geneva, Switzerland Tel: + 41 22 909 65 00 Web: http://www.gavi.org With the support of donors and partners, Gavi, the Vaccine Alliance is working to immunise an additional 300 million children between 2016 and 2020, preventing a further 5-6 million deaths. Join us and help to reach every child. Visit www.gavi.org, sign up for the Gavi newsletter and follow us on Facebook and Twitter.

WHO/HQ/EPI is interested in strengthening immunization outreach efforts by creating some related job aids for health workers.  To this end, we would appreciate your perspective on some of the barriers undermining this critical part of vaccination activities.  We request you to complete a small 5 to 10 minutes survey.    Should you know of additional experts with first-hand knowledge and experience around this issue, please forward this survey to them.  The survey will be open for participation until Monday, February 5th, though the sooner we receive enough responses, the better.  Please be aware that the survey remains fully confidential and the results will not be published, nor shared with anyone outside of the WHO-HQ EPI team. Thank you very much for your contribution!    https://www.surveymonkey.com/r/2Y6R72P

 Dear all, India is more committed, last case of WPV1 was in Jan 2011, along with other 10 countries got the certificate of eradication in March 2014. But as long as there is wild virus circulating in any part of the world, threat exists and may revert back to pre-eradication era as opined by the experts in polio. Hence India is conducting 2 rounds of Pulse Polio [NID] on 28 Jan 2018 and 11 March 2018. In Karnataka, the strategy is to administer 2 drops of Oral Polio Vaccine in the booths on day 1 followed by 2 to 3 days of house-to-house activity. In south states, from the beginning booth activity is very strong and ~90% coverage will happen on booth day itself. We expect the same this year also. The credit of eradicating polio is first given to the community, the responsible parents who brought their children to the booths and got vaccinated followed by innumerable PE’s from grass-root level workers, volunteers, NGO’s, Govt and all stakeholders. KVG Medical College, Sullia along with all other educational Institutions, NSS, NCC, Rotary, IMA along with the Govt, conducted 1 Km long rally to infuse jubilance and to create awareness to mobilize the children tomorrow. 10,845 under 5 children are expected to receive OPV tomorrow. The Block Medical Officer, MO’s of the planning units and all of us are confident to achieve ~97% coverage tomorrow itself and the remaining 3% will be covered on 29th and 30th. with regards  

Most of the countries now have improved immunization coverages and reach more children with vaccination, but we still need to monitor the potency of vaccines that are given on top of the high coverages we have achieved in many countries. One of the biggest challenges when we talk about vaccine potency is the storage condition and to be more specific “the storage temperature”. Most of the vaccines are either heat or freeze sensitive and we need to monitor the storage temperatures more closely so that we can have potent vaccines given to the children and hence achieve higher coverages with potent vaccines. There are several technologies that are currently applied in monitoring temperature of cold chain eg. VVM, Fridge and Freeze Tags, different types of RTM devices are now coming up. All this aimed at ensuring vaccines are stored in correct temperature to maintain potency. But, with all those devices the human component is not replaced and we still need someone to act upon the alarms or signs from those devices to ensure correct temperature are maintained all the time in vaccine cold chain. Based on the field experiences (9+ years) in immunization program, I am still not sure if the closed vial wastage due to freezing for freeze sensitive vaccines reflect the reality. That means, I doubt there are many children who are probably receive vaccines which have been exposed to freezing. We are very good in monitoring heat exposure because of VVM and we have observed closed vial wastage due to VVM change reported but freezing exposure is very difficult to monitor especially in the scenario when the facility does not use temperature monitoring devices that gives freezing alarms. The actions taken following low temperature excursion at the facility level makes me more worried and I feel there is a need of looking at this issue with an additional eye. Currently, many countries are getting into the new technologies of temperature monitoring but in some countries the coverage is still low. We may be proud of our improvement in the global immunization coverages but may be many of those kids are vaccinated with vaccines that are exposed to freezing. Being proud of the improvement of the global immunization coverages is good but we need to be confident that we have improved coverages with potent vaccines that are kept in recommended storage conditions. Use of modern technologies and innovations around temperature monitoring while working to improve immunization coverages is very important and this should off-course go hand in hand with behavior change on acting upon temperature excursion among those who are involved in vaccine cold chain.

Dear all Please find the attached example, illustrating the grievous impact of using vaccination cards that are not compatible with the current National Immunization Schedule (NIS). As per the study conducted recently, >10% beneficiaries avail vaccination services from the private sector ranging from clinics to Medical Colleges even in the rural area. Field supervisors / monitors have easy access to such vaccination cards both at the facility level and in the field. Negative impact strikes more than millions of children in the country. This issue can be easily addressed as already happened elsewhere in the country through advocay and supportive supervision. With best wishes Holla n team

Dear viewers  For some long standing problems, solution can be very siimple - we have to just do it. For saving the children from the lethal Vaccine Preventable Diseases (VPDs), they are to be vaccinated timely, with all the vaccines included in the National Immunization Schedule (NIS) and also optional vaccines applicable to the country. In India, for attaining Full Immunization (FIC), a child has to receive one dose of BCG, 3 doses of DPT (now included in Pentavalent), 3 doses of bOPV other than Zero OPV and one dose of Measles Containing Vaccine (MCV) before the first birth day. For complete immunization, after attaining FIC, child has to receive DPT 1st Booster and OPV between 16-24 months, with which MCV 2 is administered. Since April 2016; two doses of 0.1ml IPV are administered intradermally along with first & third doses of OPV & Pentavalent. JE / Rota and PCV are administered in selected states / districts. As per “PRACTICAL GUIDE FOR THE DESIGN, USE AND PROMOTION OF HOME BASED RECORDS IN IMMUNIZATION PROGRAMMES” by Immunization, Vaccines and Biologicals – (WHO); home-based records (HBR) currently vary in complexity across and sometimes within countries and lack standardization in content. Please find the attachment for the simplest solution. Best  wishes Holla  

CDC published Progress in Childhood Vaccination Data in Immunization Information Systems—United States, 2013–2016 (https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6643a4-H.pdf) in the November 3 issue of MMWR (pages 1178–81). A summary made available to the press is reprinted below.

IISs [Immunization Information Systems] are computerized, population-based systems that consolidate vaccination data from providers for clinical and public health use. Data from 2013–2016 were analyzed to assess progress made in four priority areas: 1) pediatric data completeness, 2) bidirectional data exchange with electronic health records, 3) pediatric clinical decision support for immunizations, and 4) ability to generate jurisdictional and provider-level vaccination coverage estimates. Progress was noted since 2013, but continued effort is needed to implement these functionalities among all IISs. Success in these priority areas bolsters public health practitioners’ ability to attain high childhood vaccination coverage and prepares IISs to develop more advanced functionalities. Success also supports the achievement of federal immunization objectives, including using IISs as supplemental sampling frames for vaccination coverage surveys.

Related Link CDC's Immunization Information Systems (IIS) web section (https://www.cdc.gov/vaccines/programs/iis/index.html)

As part of the WHO African region efforts to improve immunization and surveillance performances in terms of quality, effectiveness, efficiency, coverage and equity and in order to strengthen the capacity of policy makers and health providers in countries, there is a need for accurate data in order to gauge the effectiveness of existing policies and programs in health care system to make it more accessible and reliable. Guided by the WHO regional office, the IVD cluster of the Inter-country Support Teams for the ESA sub-region (IST/ESA) is supporting the use of innovative technologies within the immunization systems through GIS and mHealth. The rapid proliferation of mHealth projects (mostly pilot efforts), has generated considerable enthusiasm among governments, donors, and implementers of health programs. GIS and mHealth are not a new concept to be adopted and recommended by the WHO or MoHs, and they are among the key technologies that have proven impact on the quality, timeliness, and cost effectiveness of the program activities at all levels reaching up to subnational, health facility, and case-based levels (i.e. for VPD surveillance, AFP environmental surveillance, routine immunization and micro-planning, LQAs, EPI reviews, containment, certification and Monitoring & Evaluation etc.). One of the innovations is the Integrated Supportive Supervision (ISS). The ISS is an Integrated Electronic Checklist used for supervision during Active Case Search and Routine Immunization which is mostly administered by both WHO staff and Government personnel via Smart mobile phones in the field at Health Facilities and Focal Sites. These supportive visits are automatically mapped on the country profile server managed by WHO. Supportive Supervision remains the bedrock for highlighting good surveillance and routine Immunization practices through systematic visits to priority sites for assessment, evaluation and on the job training for health workers and entire health system. As we move towards the last miles of polio eradication, advanced well to eliminate measles in our sub-region, thus to bridge immunity and surveillance gaps, WHO IST/ESA has gone a step further in institutionalizing supportive supervision by encapsulating the activity into mobile format that can be administered using smart phones in order to increases the accuracy and reliability of information collected. Accuracy of data can be enhanced by proper data collection and management, the development, execution and supervision of plans, policies, programs and practices that control, protect, deliver accurate, relevant and up-to-date data in the shortest time. In the use of m-health, data collection and management has become a critical component, which requires portable software, mobile devices and the software that houses the collected information. Open Data Kit (ODK) is a free and open-source set of tools that can help organizations author, field, and manage mobile data collection solutions. In the ESA sub-region, Ethiopia, Tanzania, Madagascar, Zambia, Kenya, Uganda and South Sudan had already adopted the use of this real time mobile assisted supportive supervision with over 1,603 visits to health facilities in three months (August – October, 2017) across different regions and districts. Other countries that adopted the tool and are ready to commence using it includes South Africa, Botswana, Namibia, Malawi, Seychelles, Lesotho, Eritrea, Zimbabwe, Swaziland. The Target is to have all countries under the ESA region to conduct all their supportive supervision using smart phones to foster accountability of WHO and Government staff. It also supports other health interventions outside the EPI programmes and countries are encouraged to take advantage of the opportunity to support other health interventions (e.g. Cholera outbreak). We therefore call to Government EPI managers and surveillance officers to position themselves to embrace and use the new innovations to enable them to attain and sustain immunization and surveillance targets. Contributors as well as members of the editorial board: Dr Ahmed Y, Mr Bello I, Dr Byabamazima C, Mr Chakauya J.M, Dr Daniel, F, Dr Eshetu, M.Shibeshi, ,Dr Lebo E, Mr Katsande R, Ms Machekanyanga ,Mr Masvikeni B, Dr Manyanga D, Dr Mumba,M. Dr Okiror S,Dr Petu A, Dr Umar S and Dr Weldegebrie G.

Dear all  We wish to share the activity held in our college (KVG Medical College & Hospiatal) on 24 October 2017 with the readers.  On 24th October 2017, Rotary - Sullia branch in collaboration with KVG Medical College Hospital & IMA Sullia observed “World Polio Day”. Dr K.V. Chidananda, Medical Director, being a Surgeon is a strong supporter of all National Health Programmes, especially Immunization, Polio Eradication, MR campaigns. Rtn. Dr Sudhakar Bhat, a senior Psychiatrist, highlighted on the dedicated and active involvement of Rotary both globally and locally. Dr Narayana Holla, Assoc Professor from the Department of Community Medicine, highlighted the Past / Present and the anticipated future of polio eradication. The world has reduced the burden of polio from >350000 per year distributed in >125 countries in 1988 to 37 confirmed cases in 2016 globally – that too caused by one type – PW1.  In 2017, till date 12 confirmed cases of PW1 were detected – 7 from Afghanistan and 5 from Pakistan, both are endemic countries, Nigeria being the third – the “PAN” countries. However reducing it to zero and sustaining to eradicate at the earliest is obligatory as 61 cVDPVs were detected in the non-endemic countries. In this regard all PEs (Polio Eradicators) will ‘stop not’ as they have to go only a few “meters” for attaining the global eradication, failing which may result in as many as 200 000 new cases every year, within 10 years, all over the world. with regards Holla and the team

Following the July 2017 release of the WHO and UNICEF estimates of national immunization coverage and the corresponding chorus of concerns about sustained (i.e., a more positive alternative to the term “stagnated” that is frequently used) levels of vaccination coverage since around 2010 that seems to follow, I thought it useful to remind readers that the number of children vaccinated is increasing! Unfortunately, the number of children vaccinated from one year to the next during the recent period has not outpaced the natural population growth (as estimated by UN Population Division), a requirement for vaccination COVERAGE levels to increase over time. For example, at the global level, although estimated DTPCV3 coverage has remained around 85% since 2010, the estimated number of children who received three doses of DTPCV increased by more than 3.2 million between 2010 and 2016. Without surprise, the estimated number of surviving infants globally also increased, in fact, by more than 2.7 million from an estimated 133 to 136 million surviving infants. A similar pattern was observed among the Gavi 73 countries, for which nearly more 4.2 million children were vaccinated with DTPCV3 in 2016 than in 2010; again, the estimated number of surviving infants increased, by some 2.8 million children among Gavi 73 countries. Across the Gavi 73 countries, estimated DTPCV3 coverage was sustained at roughly the same level between 2010 and 2016 in 41 countries (estimated DTPCV3 coverage increased meaningfully in 24 countries and decreased meaningfully in eight countries). And among these 41 countries with sustained coverage levels for DTPCV3, the estimated number of children vaccinated increased between 2010 and 2016 in 31 countries by a total of more than 1 million infants. So, as the chorus of concern around sustained coverage levels is heard far and wide, from the opening session of the TechNet conference and beyond, let us give credit to the achievement of the national immunization programmes over the past 7-10 years – a period during which many programmes introduced multiple new vaccines (!), endured the effects of a global financial crisis and in some cases had to deal with civil conflict, large disease outbreaks and/or natural disasters. The achievements are noteworthy. Without question, there is more that can be and must be done moving forward…but, let’s not lose track of the fact that more children are vaccinated today than ever before and this number continues to increase.