C P Maher | PubMed Health

PubMed1993

Improving vaccination coverage: the experience of the Expanded Programme on Immunization in Vanuatu.

This paper looks at the success of measures adopted to improve vaccination coverage of infants in the Republic of Vanuatu. In 1982 the Department of Health introduced an Expanded Programme on Immunization (EPI). Since the republic has over 80 inhabited islands, a scattered population, rough terrain and a lack of transport and communications infrastructure, achieving a high vaccination coverage rate proved difficult. Coverage of infants remained low until 1987. From that year onwards various strategies were employed to increase coverage, including 1) adopting the WHO-recommended diphtheria-pertussis-tetanus (DPT) and oral polio vaccine (OPV) vaccination schedule (6, 10 and 14 weeks) instead of the former schedule (3, 6 and 9 months); 2) improving the training, support and supervision of staff delivering maternal and child health (MCH) services; and 3) improving community involvement through social mobilization activities in areas of low coverage. Data on vaccination coverage of infants for the period 1984 to 1990 were compared. Over this period coverage of infants with 3 doses of DPT rose from 29% to 76%, with 3 doses of OPV from 29% to 78%, and with measles vaccine from 19% to 66%. These dramatic improvements have largely occurred since 1987. The results demonstrate the success of the measures adopted, and the experience of Vanuatu offers lessons in improving vaccination coverage for other countries in the region.

Community Participation↗

PubMed1991

Seroepidemiology of hepatitis B infection in children in Vanuatu. Implications for vaccination strategy.

Four hundred and eighty-two unvaccinated children from three different age groups (12-18 months, 30-42 months, 54-115 months) in a hepatitis B virus (HBV) endemic area were tested for markers of HBV infection. HBV seromarkers were detected in 52.3% of children and 26.9% were hepatitis B surface antigen (HBsAg) positive. Evidence of infection was related to age, with HBV seromarker rates highest (67.5%) in school children aged 56-115 months. The HBsAg positive rate was highest (30.1%) in children 30-42 months of age. However, even children in the youngest age group (12-18 months) had high seromarker (26.8%) and HBsAg positive (17.0%) rates. A high proportion of HBsAg positive children (83.8%) were also hepatitis Be antigen (HBeAg) positive. Mothers of children in the youngest age group (12-18 months) were also tested, and 24.5% were HBsAg positive. Factors associated with higher rates of infection in children included maternal HBeAg positivity (for children in the youngest age group), increasing age, and residence on the islands of Emao or Nguna. Higher rates of HBsAg positivity were associated with these factors and with being male. Crossinfection between children is probably the most important source of infection, based on the evidence of the high rate of HBeAg positivity in children and the rising infection rate with age. A possible vehicle of spread is through skin infections and skin sores which are highly prevalent in children in Vanuatu. Since this study indicates that both perinatal and early child-to-child transmission are occurring, the most practical strategy to prevent the majority of infections is to vaccinate all children, commencing at birth and completing the course early in the first year of life.

Child↗