immunization in the americas...levels >95% for all childhood vaccines in all municipalities. 2....
TRANSCRIPT
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
immunization coverage
The Americas
North AmericaBermuda
CanadaUnited States of America
Latin America & the Caribbean
Latin America
Mexico
Central American IsthmusBelize
Costa RicaEl Salvador*
GuatemalaHondurasNicaragua
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)
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
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)
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
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
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
immunization coverage
% 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
immunization coverage
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
immunization coverage
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
Vaccination campaigns in areas at risk
Vaccination campaigns in areas at risk, 2007
…
NA
NA
Vaccination campaigns in areas at risk, 2008
Mass campaigns since 2004 startingin areas at higher risk
NA
NA
Vaccination campaigns in areas at risk
immunization coverage
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
PneumococcusRotavirus
Human Papillomavirus
Pneumococcus
Human Papillomavirus
Pneumococcus
PneumococcusRotavirus