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Saturday, 4th of April 2009 Print




PATH is pleased to announce the launch of a new website www.eddcontrol.org, which includes many resources for diarrheal control This resource-rich site provides tools that advocates and practitioners alike can use in spreading the word about the deadly toll of diarrheal disease and the solutions to stop it.

In addition to established interventions that include oral rehydration therapy, breastfeeding, clean water, and hygiene, new tools like zinc and diarrhea vaccines bring new opportunities to re-invigorate interest and investments toward addressing the second-leading cause of child death.

Presented in partnership with UNICEF, the website includes key documents and links to information on these simple, lifesaving interventions, as well as highlights of in-country programs that are putting them in the hands of mothers and caregivers.

Deborah Phillips (




Ryman and her CDC colleagues review the literature on improving routine immunization in developing countries. Not surprisingly, they find huge numbers of descriptive articles, and very few analytic pieces. Full text is at http://www.biomedcentral.com/1472-6963/8/134 The summary follows.


Now that GAVI and other partners have put hundreds of millions of dollars into routine immunization, is it time to find out, in a more systematic way, what works?


Good reading.





1: BMC Health Serv Res. 2008 Jun 21;8:134.

Too little but not too late: results of a literature review to improve routine immunization programs in developing countries.

Ryman TK, Dietz V, Cairns KL.

Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road MS-E05, Atlanta, GA 30333, USA. tryman@cdc.gov

BACKGROUND: Globally, immunization services have been the center of renewed interest with increased funding to improve services, acceleration of the introduction of new vaccines, and the development of a health systems approach to improve vaccine delivery. Much of the credit for the increased attention is due to the work of the GAVI Alliance and to new funding streams. If routine immunization programs are to take full advantage of the newly available resources, managers need to understand the range of proven strategies and approaches to deliver vaccines to reduce the incidence of diseases. In this paper, we present strategies that may be used at the sub-national level to improve routine immunization programs.


METHODS: We conducted a systematic review of studies and projects reported in the published and gray literature. Each paper that met our inclusion criteria was rated based on methodological rigor and data were systematically abstracted. Routine-immunization - specific papers with a methodological rigor rating of greater than 60% and with conclusive results were reported.


RESULTS: Greater than 11,000 papers were identified, of which 60 met our inclusion criteria and 25 papers were reported. Papers were grouped into four strategy approaches: bringing immunizations closer to communities (n = 11), using information dissemination to increase demand for vaccination (n = 3), changing practices in fixed sites (n = 4), and using innovative management practices (n = 7).


CONCLUSION: Immunization programs are at a historical crossroads in terms of developing new funding streams, introducing new vaccines, and responding to the global interest in the health systems approach to improving immunization delivery. However, to complement this, actual service delivery needs to be strengthened and program managers must be aware of proven strategies. Much was learned from the 25 papers, such as the use of non-health workers to provide numerous services at the community level. However it was startling to see how few papers were identified and in particular how few were of strong scientific quality. Further well-designed and well-conducted scientific research is warranted. Proposed areas of additional research include integration of additional services with immunization delivery, collaboration of immunization programs with new partners, best approaches to new vaccine introduction, and how to improve service delivery.

PMID: 18570677 [PubMed - indexed for MEDLINE]



In this Lancet article, available online at http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60317-2/fulltext?_eventId=login

Clark and Sanderson review survey data from 45 low- and middle-income countries on the timing of children’s vaccinations. Lamentably, some countries do less well than others.


Authors’ summary:


The Lancet, Early Online Publication, 20 March 2009

doi:10.1016/S0140-6736(09)60317-2 Cite or Link Using DOI

Timing of children's vaccinations in 45 low-income and middle-income countries: an analysis of survey data

Original Text

Andrew Clark MA a, Dr Colin Sanderson PhD a



Vaccinations are often delayed until well after the recommended ages, leaving many children exposed for longer than they should be. We estimated vaccination coverage at different ages, and delays in administration, in 45 low-income and middle-income countries.


We used data for 217 706 children from Demographic and Health Surveys between 1996 and 2005 (median 2002), which provided data for vaccination of children on the basis of events recorded on vaccination cards and interviews with mothers, with imputation of missing values and survival analysis. We devised an index combining coverage and delay.


For vaccinated children, the median of the median delays in the 45 countries was 2·3 weeks (IQR 1·4—4·6) for bacille Calmette-Guérin (BCG); 2·4 weeks (1·2—3·3) for diphtheria, tetanus, and pertussis (DTP1); 2·7 weeks (1·7—3·1) for measles-containing vaccine (MCV1); and 6·2 weeks (3·5—8·5) for DTP3. However, in the 12 countries with the longest delays for each vaccination, at least 25% of the children vaccinated were more than 10 weeks late for BCG, 8 weeks for DTP1, 11 weeks for MCV1, and 19 weeks for DTP3. Variation within countries was substantial: the median of the IQRs in the 45 countries for delay in DTP3 was 10·9 weeks, 7·9 weeks for MCV1, 5·4 weeks for BCG, and 5·3 weeks for DTP1. The median of the national coverage rates for DTP1 increased from 57% in children aged 12 weeks to 88% at 12 months, and for DTP3 from 65% at 12 months to 76% at 3 years.


The timeliness of children's vaccination varies widely between and particularly within countries, and published yearly estimates of national coverage do not capture these variations. Delayed vaccination could have important implications for the effect of new and established vaccines on the burden of disease.


WHO's Initiative for Vaccine Research.

a Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK

Correspondence to: Dr Colin Sanderson, Health Services Research Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK