WHO-Recommended Standards for Surveillance of Selected Vaccine-Preventable Diseases
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WHO-Recommended Standards for Surveillance of
Selected Vaccine-Preventable Diseases - extracted text
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WHO-recommended
standards for surveillance of
selected vaccine-preventable
diseases
z
GLOBAL PROGRAMME FOR VACCINES AND IMMUNIZATION
EXPANDED PROGRAMME ON IMMUNIZATION
World Health Organization
WHO/EPI/GEN/98.01
ORIGINAL: ENGLISH
DISTR.: GENERAL
■ health
WHO-recommended standards
for surveillance of selected
vaccine-preventable diseases
GLOBAL PROGRAMME FOR VACCINES AND IMMUNIZATION
EXPANDED PROGRAMME ON IMMUNIZATION
World Health Organization
Geneva
1998
The Global Programme for Vaccines and Immunization
thanks the donors whose unspecified financial support in 1997
has made the production of this document possible.
Ordering code: WHO/EPI/GEN/98.01
Printed: June 1998
This, and other documents produced by GPV, are available on the Internet at:
http://www.who.ch/gpv-documents/
»
Copies may be requested from:
World Health Organization
Global Programme for Vaccines and Immunization
CH-1211 Geneva 27, Switzerland'
* Fax: +22 791 4193/4192 • E-mail: gpv@who.ch •
© World Health Organization 1998
This document is not a formal publication of the World Health Organization (WHO), and all rights are
reserved by the Organization. The document may, however, be freely reviewed, abstracted, reproduced
and translated, in part or in whole, but not for sale nor for use in conjunction with commercial purposes.
The views expressed in documents by named authors are solely the responsibility of those authors.
Contents
1st of acronyms
iv
itro duction
v
iphtheria
cute viral hepatitis
aemophilus influenzae type B (Hib) disease
teasles
11
sonatal tetanus
15
irtussis (whooping cough)
18
•lliomyelitis
21
Blow fever
26
unex 1: WHO headquarters and regional office contacts
30
iii
The Global Programme for Vaccines and Immunization
thanks the donors whose unspecified financial support in 1997
has made the production of this document possible.
Ordering code: WHO/EPI/GEN/98.01
Printed: June 1998
This, and other documents produced by GPV, are available on the Internet at:
hnp://www.who.ch/gpv-documents/
i
Copies may be requested from:
World Health Organization
Global Programme for Vaccines and Immunization
CH-1211 Geneva 27, Switzerland'
* Fax: +22 791 4193/4192 • E-mail: gpv@who.ch •
© World Health Organization 1998
This document is not a formal publication of the World Health Organization (WHO), and all rights are
reserved by the Organization. The document may, however, be freely reviewed, abstracted, reproduced
and translated, in part or in whole, but not for sale nor for use in conjunction with commercial purposes.
The views expressed in documents by named authors are solely the responsibility of those authors.
Contents
Lis.t of acronyms.......................................................................................................... iv
Introduction.................................................................................................................. v
Diiphtheria
.
A»cute viral hepatitis
4
Hlaemophilus influenzae type B (Hib) disease....-™........................... 7
Measles....................................................................................... —~—....................... 11
Weonatal tetanus...................................................................................................... 15
IPertussis (whooping cough)..................................................................................... 18
^Poliomyelitis............................................................................................................... 21
Yellow fever................................................................................................................ 26
Annex 1: WHO headquarters and regional office contacts.............................. 30
iii
List of acronyms
AFRO
9GPW
AFRO
AFP
AMRO
CIE
CSF
DTP3
EMRO
EPI
EURO
GPV
HAV
HBc
HBV
HCV
HDV
HEV
HBsAg
HepB3
Hib3
IgA
IgG
IgM
ml
NT
OPV3
PAB
PCR
SEARO
TT
TT2+
WHO
WPRO
WHO Regional Office for Africa
9th Global Programme of Work
WHO Regional Office for Africa
Acute flaccid paralysis
WHO Regional Office for the Americas
counter immunoelectrophoresis
cerebrospinal fluid
third dose of diphtheria-tetanus-pertussis vaccine
WHO Regional Office for the Eastern Mediterranean
Expanded Programme on Immunization
WHO Regional Office for Europe
Global Programme for Vaccines and Immunization
hepatitis A virus
hepatitis B core
hepatitis B virus
hepatitis C virus
hepatitis D virus
hepatitis E virus
hepatitis B surface antigen
third dose of hepatitis B vaccine
third dose of Haemophilus influenzae type b vaccine
immunoglobulin A
immunoglobulin G
immunoglobulin M
millilitre
neonatal tetanus
third dose of oral polio vaccine
protected at birth
polymerase chain reaction
WHO Regional Office for South-East Asia
tetanus toxoid
second and subsequent doses of tetanus toxoid
World Health Organization
WHO Regional Office for the Western Pacific
Introduction
The purpose of this document is to provide WHO recommendations on surveillance
standards for selected vaccine-preventable diseases. These recommendations should
be carefully adapted to meet national needs according to a country’s own disease
control priorities, objectives and strategies.
Disease surveillance is defined as the routine ongoing collection, analysis and dis
semination of health data. An effective surveillance system has the following func
tions:
detection and notification of health events
collection and consolidation of pertinent data
investigation and confirmation (epidemiological, clinical and/or laboratory) of
cases or outbreaks
routine analysis and creation of reports
feedback of information to those providing the data, and
feed-forward (i.e. the forwarding of data to more central levels).
The rationale for surveillance of a specific health event must be established and
based on clear national priorities, disease control objectives and strategies; other
wise, the disease surveillance data collected may be irrelevant. Decisions as to what
data to collect should be based on what analyses are needed to guide public health
decision-making. To avoid overburdening health staff at peripheral levels, the sur
veillance system should be as streamlined as possible by collecting the minimum
amount of data necessary, and by using the most efficient and appropriate means to
collect, consolidate and transfer data. Staff at all levels should be trained and encour
aged to analyse and use their data. Data that can be more efficiently collected from
other sources (e.g. survey) should not be included in a surveillance system.
An effective surveillance system is:
•
useful
•
efficient
•
flexible
•
representative
•
simple
V
These attributes should be assessed when evaluating a surveillance system.
At the national level, clear surveillance “standards” must be established for maxi
mum efficiency and so that data are comparable throughout the country. These stan
dards would include:
•
a case definition
•
the type of surveillance to be conducted
•
the data elements to be collected
•
the minimum analyses and routine reports to be created
•
the use of data for making decisions
For surveillance to be operational, the following needs to be carefully defined:
•
the process of surveillance
•
the tasks at each level
•
the data/specimen flow
•
the logistics, including staff issues
designation of staff
staff training
appropriate tool distribution (e.g. means of communication, transportation,
specimen kits)
As a part of supervision, standard performance indicators should be monitored to
identify weaknesses in the system so that corrective action can be taken.
vi
Diphtheria
Rationale for surveillance
Diphtheria is a widespread severe infectious disease that has the potential for epidemics.
The control of diphtheria is based on the following three measures. 1) Primary prevention
of disease by ensuring high population immunity through immunization. 2) Secondary
prevention of spread by the rapid investigation of close contacts, to ensure their proper
treatment. 3) Tertiary prevention of complications and deaths by early diagnosis and
proper management. Surveillance data can be used to monitor levels of coverage
(target > 90%) and disease as a measure of the impact of control programmes. Recent
epidemics have highlighted the need for adequate surveillance and epidemic prepared
ness.
Recommended case definition
Clinical description
An illness characterised by laryngitis or pharyngitis or tonsillitis, and
an adherent membrane of the tonsils, pharynx and/or nose.
Laboratory criteria for diagnosis
Isolation of Corynebacterium diphtheriae from a clinical specimen, or
fourfold or greater rise in serum antibody (but only if both serum samples were obtained
before the administration of diphtheria toxoid or antitoxin).
Case classification
Suspected:
Not applicable
Probable:
A case that meets the clinical description
Confirmed:
A probable case that is laboratory confirmed or linked epidemiologically to a laboratory confirmed case
Note:
Persons with positive C. diphtheriae cultures and not meeting the clinical de
scription (i.e. asymptomatic carriers) should not be reported as probable or
confirmed diphtheria cases.
Recommended types of surveillance
•
Routine monthly reporting of aggregated data of probable or confirmed cases is
recommended from peripheral level to intermediate and central levels. Zero reporting
should be required at all levels
•
All outbreaks should be investigated immediately and case-based data collected
•
In countries achieving low incidence (usually where coverage is >85-90%) immediate
reporting of case-based data of probable or confirmed cases is recommended from
peripheral level to intermediate and central levels
WHO/EPI/GEN/98.01
1
Diphtheria (continued)
Recommended minimum data elements
Aggregated data:
•
Number of cases
•
Number of third doses of diphtheria toxoid containing vaccine (e.g. DTP3) adminis
tered to infants
Case-based data:
•
Unique identifier
•
Geographical area (e.g. district) name
•
Date of birth
•
Date of onset
•
Date of first treatment
•
Treatment type:
1 =antibiotic & antitoxin; 2=antibiotic only; 3=antitoxin only; 4=no or other treatment;
9=unknown.
•
Laboratory result:
1=toxigenic C. diphtheriae isolated; 2=non-toxigenic C. diphtheriae isolated;
3=C. diphtheriae isolated, toxigenicity unknown; 4=C. diphtheriae not isolated;
5=no specimen processed; 9=unknown.
•
Total diphtheria vaccine (DTP, DT or Td) doses received
•
Date of last dose
•
Final classification of the case:
1 confirmed; 2=probable; 3=discarded
•
Outcome:
1 =alive; 2=dead; 3=unknown
Recommended data analyses, presentation, reports
Aggregated data:
•
Incidence rate by month, year, and geographic area
/
•
DTP3 coverage by year and geographic area
•
Completeness/timeliness of monthly reporting
•
Proportional morbidity (compared to other diseases of public health importance)
Case-based data: same as aggregated data plus the following:
2
•
Age-specific incidence rate
•
Cases by immunization status, laboratory results, treatment type
•
Cases treated “on time” (< seven days of onset)
•
Case fatality rate
•
Proportional mortality (compared to other diseases of public health importance)
WHO-recommended standards for surveillance
Diphtheria (continued)
Special aspects
More detailed information available from the Expanded Programme on Immunization
(EPI), Global Programme for Vaccines and Immunization (GPV).
Principle uses of data for decision-making
•
Monitor case fatality rate and, if high, determine cause (e.g. poor case manage
ment, lack of antibiotics/anti-toxin, patients not seeking treatment in time) so that
corrective action can be taken
•
Determine age-specific incidence rate, geographical area, and season of diphtheria
cases to know risk groups and risk periods
•
Monitor incidence rate to assess impact of control efforts
•
Monitor immunization coverage per geographical area to identify areas of poor
programme performance
•
Detect outbreaks and implement control measures
•
Investigate outbreaks to understand epidemiology, determine why the outbreak
occurred (e.g. vaccine failure, failure to immunise, accumulation of susceptibles,
waning immunity, new toxigenic strain), and ensure proper case management
Note:
In addition to surveillance, carefully designed serologic studies can be used to
monitor the immune status of different age groups.
Contact information
Regional offices
See Annex 1
Headquarters
WHO Global Programme for Vaccines and Immunization (GPV),
(See Annex 1 for address/fax number)
E-mail: MelgaardB@who.ch / GPV@who.ch
Tel: +41 22 791 4408
WHO/EPI/GEN/98.01
3
Acute viral hepatitis
Rationale for surveillance
Several distinct infections are grouped as viral hepatitis. Transmission is mainly through
the oral-faecal route for hepatitis A_and_E> and percutaneous exposureto^bodyfluids,
including sexual intercoure, for hepatitis B, C, and D. The course of the disease may be
fulminating (e.g. hepatitis E in pregnancy); chronic infection and severe sequel occur
mainly for hepatitis B, C, and D.
Control measures for blood-related transmission include ensuring transfusion safety,
injection safety, and (for hepatitis A and hepatitis B at least) immunization. Hepatitis B is
targeted by WHO (9GPW6.3) for reduced incidence/prevalence
Recommended case definition
Clinical description
An acute illness typically including acute jaundice, dark urine, anorexia, malaise,
extreme fatigue, and right upper quadrant tenderness. Biologic signs include increased
urine urobilonogen and >2.5 times the upper limit of serum alanine aminotransferase.
Note:
Most infections occur during early childhood.
A variable proportions of adult infections are asymptomatic.
Laboratory criteria for diagnosis
Hepatitis A:
positive for IgM anti-HAV
Hepatitis B:
positive for IgM anti-HBc-positive or (less preferably) hepatitis B
surface antigen (HBsAg)
Non-A, non-B:
negative for IgM anti-HAV and IgM anti-HBc or (less preferably) HBsAg
Note:
The anti-HBc IgM test, specific for acute infection, is not available in most
countries. HbsAg is often available, but is less preferable since it cannot distin
guish acute new infections from exacerbation of chronic hepatitis B. Neverthe
less, continued HBsAg seropositivity (> six months) is an indicator of chronic
infection. For patients with non-A, non-B, the following testing is used for a
diagnosis of acute hepatitis C, D, or E:
Hepatitis C:
Hepatitis D:
positive for anti-HCV
positive for IgM anti-HBc or (less preferably) HBsAg plus anti-HDV /
positive (N.B. only occurs as co-infection or super-infection of
hepatitis B)
Hepatitis E:
positive for IgM anti-HEV
Case classification
Suspected:
A case that is compat:ble with the clinical description
4
Probable:
Not applicable
Confirmed:
A suspected case that is laboratory confirmed or,
for hepatitis A only, a case compatible with the clinical description, in
a person who has an epidemiological link (i.e. household or sexual
contact with an infected person during the 15-50 days before the onset
of symptoms) with a laboratory-confirmed case of hepatitis A
WHO-recommended standards for surveillance
Acute viral hepatitis (continued)
Recommended types of surveillance
•
Routine monthly reporting of aggregated data of suspected cases, and if available,
the number of confirmed cases of each type of hepatitis is recommended from the
peripheral level to intermediate and central levels
•
Zero reporting should be required at all levels
•
All outbreaks should be investigated immediately and confirmed serologically
Recommended minimum data elements
Aggregated data:
•
Number of third doses of hepatitis B vaccine (HepB3) administered to infants
•
Number of suspect cases
•
If available, number of confirmed cases by each type of hepatitis
Recommended data analyses, presentation, reports
(from multiple sources of data, in addition to surveillance data):
•
HepB3 coverage in infants by year and geographic area
•
Acute viral hepatitis incidence by year, month, geographical area, and (if data exist)
age group
•
Where data exist on etiologic agent, incidence rate of each type of acute viral
hepatitis by geographic area, year, month and age group
•
Proportion of all cases of chronic liver disease, cirrhosis, and primary liver cancer
that are HBsAg positive or anti-HCV positive.(see special aspects section)
Principle uses of data for decision-making
•
Monitor HepB3 coverage by geographic area to measure areas with weak perfor
mance and take action
•
Investigate all suspected/reported outbreaks
•
Determine the specific cause of acute viral hepatitis cases (reported routinely or
during outbreaks), so that corrective measures can be taken
•
Understand the epidemiology of hepatitis by etiologic agent in terms of distribution
over time, by age group, and by geographic area
•
Measure the incidence (including age-specific incidence) and prevalence of HBsAg
and anti-HCV
•
Measure the proportion of acute viral hepatitis, chronic liver disease, cirrhosis, and
/primary liver cancer that are hepatitis B virus or hepatitis C virus carriers to:
/ 1) determine the burden of the disease in the population;
2)
3)
prioritize it among other diseases of public health importance; and
choose the proper strategies for its control
WHO/EPI/GEN/98.01
5
Acute viral hepatitis (continued)
Special aspects
Surveillance data of acute viral hepatitis from developing countries should be interpreted
with caution. Differentiation of types of viral hepatitis (A to E) based on clinical diagnosis
is unreliable and serologic testing is necessary for accurate diagnosis. Unfortunately,
many developing countries do not have access to diagnostic reagents. Most infections
with hepatitis A, B, C and E virus occur asymptomatically (in developing countries
usually among children) and will not be detected and reported to the surveillance system.
Therefore, a low incidence of acute viral hepatitis should not be misinterpreted as a low
prevalence of viral hepatitis infection.
Understanding the epidemiology and burden of disease of viral hepatitis requires an
understanding of the sequellae of hepatitis B, C and D infection. These includes asymp
tomatic chronic infection, chronic hepatitis, cirrhosis, and primary liver cancer. Measuring
the burden of these conditions requires data collection from sources not traditionally
used by infectious disease epidemiologists, including data on hospital discharge and
mortality data (for chronic hepatitis, cirrhosis, and liver cancer), and cancer registers.
Special sero-prevalence surveys may be needed to measure the prevalence of hepatitis B
and hepatitis C infection in the general population and in special groups such as blood
donors, pregnant women, military recruits, health care workers, certain patient groups
(e.g. patients with liver disease, people on dialysis, haemophiliacs), and ethnic sub
populations.
Assessing coverage of hepatitis B vaccine is similar to that for other EPI vaccines.
Vaccine is given to infants (and in some industrial countries to adolescents) primarily to
prevent the development of chronic liver disease and liver cancer; serological testing to
document sero-conversion in children is usually not necessary because numerous
studies have shown that the vaccine is 85% to 100% effective in preventing chronic
infection.
Contact information
Regional offices
See Annex 1
Headquarters
WHO Global Programme for Vaccines and Immunization (GPV)
E-mail: KaneM@who.ch / GPV@who.ch
Tel: +41 22 791 2605
WHO Division of Emerging and Other Communicable Diseases, Surveillance and
Control (EMC)
E-mail: lavanchyd@who.ch
Tel: +41 22 791 2656
N.B. (See Annex 1 for addresses/fax numbers)
6
WHO-recommended stanoards for surveillance
Haemophilus influenzae type B (Hib) disease
Rationale for surveillance
Hib is the most common cause of bacterial meningitis in children, and one of the two
most common causes of severe bacterial pneumonia. Pneumonia is the largest single
remaining infectious disease killer of young children in the developing world. Hib may
also cause other diseases, including arthritis, skin infection, and epiglottitis. Surveillance
data are critical for clarifying the burden of disease and evaluating the impact of immuni
zation programmes. Although in many countries Hib pneumonia is more common than
the other types of infection, diagnosis of Hib pneumonia is extremely difficult. Routine
surveillance should focus on meningitis and other Hib infections, diagnosed with micro
biologic tests on blood, cerebrospinal fluid (CSF), and other body fluids (such as pleural
fluid) that usually do not contain bacteria. Such infections are often called “invasive Hib
disease”. Countries may also wish to report potential cases of bacterial meningitis, both
as a performance indicator for Hib detection, and to clarify the burden of meningitis
attributable to all bacteria.
Recommended case definition
Clinical description
Bacterial meningitis is characterized by acute onset of fever, headache and stiff neck.
Meningitis is not specific for Hib disease, and Hib disease cannot be diagnosed on
clinical grounds.
Laboratory criteria for diagnosis
Culture method: isolation of Hib from a normally sterile clinical specimen, such as
cerebrospinal fluid (CSF) or blood (i.e. culture of Hib from a non-sterile site, such as the
throat, does not define Hib disease, since the bacteria can grow in these other areas and
not cause disease). Antigen detection methods: identification of Hib antigen in normally
sterile fluids (i.e. CSF or blood) by antigen detection methods such as latex agglutination
or counter immunoelectrophoresis (CIE).
Case classification
Potential:
Bacterial meningitis case: a child with a clinical syndrome consistent
with bacterial meningitis
Probable:
Not applicable
Confirmed:
A case that is laboratory confirmed by growing or identifying Hib in the
CSF or blood
Note:
Any person with Hib isolated from CSF or blood may be reported as a confirmed
case, regardless of whether their clinical syndrome was meningitis.
WHO/EPI/GEN/98.01
7
Haemophilus influenzae type B (Hib) disease (continued)
Recommended types of surveillance
•
Routine monthly reporting of aggregate data of confirmed cases is recommended
from peripheral level to intermediate and central levels
•
Zero reporting should be required at all levels
•
All potential cases should also be reported if laboratory performance indicators are
to be monitored (see Note)
Note:
Since laboratory confirmation is required for all cases, the extent of surveillance
will of necessity vary depending on the capabilities of individual countries.
Surveillance does not need to be national in scope to fulfil goals as noted in
“Rationale” section above. It is more important to have a well-functioning system
in some areas than to have a national system that functions poorly.
Recommended minimum data elements
Aggregated data for reporting
•
Number of cases
•
Number of 3rd doses of Hib vaccine (Hib3) administered to infants
Case-based data for reporting and investigation
•
Unique identifer
•
Geographical area (e.g. district and province) names
•
Date of birth
•
Date of onset
•
Specimen type, if specimen collected:
1=blood; 2=CSF; 3=both; 4=other
•
Culture result, if done:
1=positive; 2=negative; 3=pending; 4=notdone
•
Antigen detection result, if done:
1=positive; 2=negative; 3=pending; 4=not done
•
CSF white cell count/ml, if done
•
Outcome:
1 =alive; 2=dead; 9=unknown
•
Number of Hib doses received:
9=unknown
•
Final classification:
1 =potential; 2=confirmed
Recommended data analyses, presentation, reports
Aggregated data
•
Incidence rate by year and geographic area
8
•
Hib3 coverage by year and geographic area
•
Completeness and timeliness of reporting
WHO-recommended standards for surveillance
Haemophilus influenzae type B (Hib) disease (continued)
Case-based data: Same as aggregate plus:
•
Age-specific incidence rate
•
Case fatality rate
•
Cases by immunization status
•
Performance indicators of surveillance quality
Percent of all potential bacterial meningitis cases for
which CSF/blood was obtained for evaluation
Percent of potential bacterial meningitis cases in which
a bacterial pathogen was identified from CSF or blood:
- Among CSF with 10 or more white blood cells/ml
Among CSF with 100 or more white blood cells/ml
Note:
Target
> 90%
> 20%
> 50%
Although persons with bacterial meningitis have a wide range of CSF white blood
cell counts, the proportion of potential bacterial meningitis cases with identifiable
bacterial causes increases with increasing CSF cell counts. For evaluation of
performance, programme personnel may wish to determine proportion of potential
bacterial meningitis cases in which bacterial causes have been identified in one
or both of the above categories. Results below the target levels suggest some
cases of bacterial meningitis are not being identified, and that review of laboratory
and clinical practices should be performed.
Principle uses of data for decision-making
•
To determine incidence of Hib meningitis and invasive disease for estimation of Hib
disease burden
•
To measure impact of immunization program and identify areas needing additional
input
•
To monitor coverage and take action to correct low coverage areas
Special aspects
Since Hib surveillance requires laboratory confirmation,.nation-wide surveillance may not
be practical in many countries. However, most surveillance goals may be approached
with a less comprehensive plan. Surveillance in areas with appropriate clinical and
laboratory capacity can provide necessary information on burden and immunization
impact. Coverage data should be obtained nation-wide. Evaluating me combination of
nation-wide coverage data, and area-specific disease data can provide necessary infor
mation for making immunizavc. • • •« egramme decisions. Additional guidance on surveil
lance methodology can oe obtained in WHO publication WHO/VRD/GEN/95.05.
WHO/EPI/GEN/98.01
9
Contact information
Regional offices
See Annex 1
Headquarters
WHO Global Programme for Vaccines and Immunization (GPV)
(See Annex 1 for address/fax number)
E-mail: WengerJ@who.ch / GPV@who.ch
Tel: +41 22 791 4511
10
WHO-recommended standards for surveillance
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Measles
Rationale for surveillance
Measles is targeted for a reduction Dy 90% in incidence and by 95% in mortality
(9GPW 6.2). Surveillance for measles should evolve with each phase of measles control.
Countries in the "me.asl.es_contror phase are endemic and should concentrate on raising
routine measles ifrimurfizatidncoverage and focusing extra immunization efforts in areas
with high measles morbidity. Countries in the more advanced “measles outbreak preveption phase” are achieving high routine measles coverage and low Incidence with periodic
outbreaks. Surveillance in these countries should be used to predict ootential outbreaks ’
and identify high risk areas and populations. Countries in the me
elimination phase” in which the objective is to completely interrupt measles trans n
.
require very intensive case-based suryeittaneg to deter/
ron^rm everv
suspect measles case in the community.
Recommended case definition
Clinical case definition
Any person in whom a clinician suspects measles infection or
any person with fever, and maculopapular rash (i.e. non-vesicular), and cough, coryza
(i.e. runny nose) or conjunctivitis (i.e. red eyes)
Laboratory criteria for diagnosis
At least a four-fold increase in antibody titre, or isolation of measles virus, or presence of
measles-specific IgM antibodies.
Case classification
Probable:
Not applicable
Clinically confirmed:
A case that meets the clinical case defK:.on
Laboratory confirmed* A case that meets the clinical case definition and that is
laboratory confirmed or
linked epidemiologically to a laboratory confirmed case.
* only for outbreak confirmation and during the elimination phase
Recommended types of surveillance
•
Control phase: When measles is endemic, routine mnnthlv reoorting of aggreaated
data of clinical measles cases from peripheral to interm.ee-'-> ctrJ central feve‘. Only
outbreaks (not each case) should be investigated
•
Outbreak prevention phase: Wnen low incidence of measles is achieved with
periodic outbreaks due to accumulation of susceptibles, routine monthly reporting of
aggregated data of clinical measles cases is recommended from peripheral to
intermediate and central level. All suspected outbreaks should be investigated
immediately and case-based data collected. Suspected measles epidemics should
be confirmed by conducting serology on the first few cases only
•
Elimination phase: Case-based surveillance should be conducted and every case
reported and investigated immediately from peripheral level to intermediate level, and
also included in the weekly reporting system. Laboratory specimens should be
collected on every case
•
During all phases: zero reporting should be required at all levels
WHO/EPI/GEN/98.01
11
Measles (continued)
Recommended minimum data elements
Control phase (aggregated data):
•
Number of cases
•
Number of measles vaccine doses administered to infants (or one year of age
depending on the immunization schedule)
Outbreak prevention phase (aggregated data): same as control phase, plus the
following:
•
Number of cases by age group and immunization status
Elimination phase (case-based data):
•
Unique identifier
•
Geographical area (e.g. district and province) names
•
Date of birth
•
Date of rash onset
•
Date of notification
•
Date of case investigation
•
Date of specimen collection
•
Number of measles vaccine doses received:
99=unknown
•
Source of infection identified:
1=yes; 2=no; 9=unknown
•
Results of serology:
1 =positive; 2=negative; 3=no specimens processed; 9=unknown
•
Final classification:
1 =clinically confirmed; 2=confirmed by laboratory; 3=confirmed by
epidemiological-link; 9=discarded
Note:
I
I
In every phase, completeness and timeliness of weekly measles reporting should
be monitored.
Recommended data analyses, presentation, reports
/
For control phase
•
Incidence rate by month, year, and geographic area
•
Measles vaccine coverage by year and geographic area
•
Completeness/timeliness of monthly reporting
•
Proportional morbidity (compared to other diseases of public health importance)
•
Proportion of known outbreaks that were investigated
For outbreak prevention phase: same as control phase plus the following:
•
Age-specific incidence rate
•
Cases by age group and immunization status
12
i
WHO-recommended standards for surveillance
Measles (continued)
Measles elimination: same as outbreak prevention phase plus the following:
Performance indicators
Target
% of weekly reports received
% of cases* notified £ seven days of rash onset
% of cases* investigated < 48 hours of notification
% of cases* with adequate specimen** and lab results
% of confirmed cases with source of infection identified
>80%
£80%
>80%
£80%
£80%
* all cases that meet the clinical case definition
** adequate specimen is one blood specimen collected within 3-28 days of rash
onset
Principle uses of data for decision-making
•
Control phase: Monitor incidence and coverage to monitor progress (e.g. decreas
ing incidence and increasing coverage), and to identify areas at high risk or with poor
programme performance
•
Outbreak prevention phase: Describe the changing epidemiology of measles in
terms of age and inter-epidemic period. Identify high-risk populations. Determine
when the next outbreak may occur due to a build-up of susceptibles and accelerate
activities beforehand
•
Elimination phase: Use data to classify cases (See special aspects section)
Determine where measles virus is circulating or may circulate (i.e. high risk) and the
performance of the surveillance system (e.g. reaction time for notification, and
specimen collection) to detect virus circulation or potential importation
•
During all phases: Detect and investigate outbreaks to ensure proper case man
agement, and determine why the outbreak occurred (e.g. failure to vaccinate,
vaccine failure or accumulation of susceptibles)
Special aspects
Figure 1: Final classification of measles cases (elimination phase)
IgM negative
Adequate blood
specimen
Suspect
measles cases
Discard
IgM positive
Laboratory
confirmed
Epidemiologic link to
laboratory confirmed case
No adequate blood
specimen
No epidemiologic link to
laboratory confirmed case
WHO/EPI/GEN/98.01
Clinically
confirmed
13
Measles (continued)
Contact information
Regional offices
See Annex 1
Headquarters
WHO Global Programme for Vaccines and Immunization (GPV)
(See Annex 1 for address/fax number)
E-mail: OliveJ@who.ch/GPV@who.ch
Tel:+41 22 791 4409
14
WHO-recommended standards for surveillance
Neonatal tetanus
Rationale for surveillance
Neonatal tetanus, is targeted by WHO for elimination as a major public health burden
(9GPW 6.2). High tetanus toxoid (TT)_coverage of pregnant women, cfean delivery and
the identification of, and implementation of corrective action inhigh risk areas (i.e. TT
immunization of childbearing-aged women) are the three primary strategies towards this
goal. Epidemiological surveillance is useful in the identification of areas at high risk for
neonatal tetanus (NT) and for monitoring impact of interventions.
Recommended case definition
Clinical case definition and case classification
Suspected case: Any neonatal death between 3-28 days of age in which the cause of
death is unknown; or any neonate reported as having suffered from
neonatal tetanus between 3-28 days of age and not investigated
Confirmed case: Any neonate with a normal ability to suck and cry during the first two
days of life, and who between three and 28 days of age cannot suck
normally, and becomes stiff or has convulsions (i.e. jerking of the
muscles) or both
Note:
The basis for case classification is entirely clinical and does not depend upon
laboratory confirmation. NT cases reported from hospitals are considered con
firmed.
Recommended types of surveillance
•
Number of confirmed NT cases should be included in routine monthly surveillance
reports of all countries and should be reported as a separate item from other (nonneonatal) tetanus. Zero reporting should be required at all levels
•
Active surveillance for NT should be conducted in major health facilities on a regular
basis
•
A retrospective record review for NT cases should be conducted at least once
annually in major hospitals
•
In “low risk” geographical areas where NT incidences/1000 live births and surveil
lance is performing well (i.e. surveillance data are reasonably representative of the
population and there is good reporting completeness), all suspect cases should be
investigated to confirm and identify the cause
•
Communitysuryeillance is recommended in “silent” areas (i.e. where routine report
ing is not functional but, based on other indicators,-where neonatal tetanus could be
a problem)
Recommended minimum data elements
Aggregated data:
•
Number of cases
•
Doses of TT administered to pregnant or child-bearing aged women (depending on
national policy) or % of newborns protected at birth (PAB) [see special aspects
section]
•
Completeness/timeliness of monthly reports
WHO/EPI/GEN/98.01
15
Neonatal tetanus (continued)
Case-based data:
•
Unique identifier
•
Geographical area (e.g. district and province) names
•
Date of birth of baby
•
Age (in days) of baby at onset
•
Sex of baby
•
Parity (number of deliveries including this most recent one) of mother
•
Date of case investigation
•
Location/type of birth:
1 institution; 2=home with trained attendant; 3=home with untrained attendant;
4=home without attendant; 5=other; 9=unknown
•
Tetanus immunization status of mother when she gave birth:
1 =up-to-date; 2=not up-to-date; 3=unimmunised; 9=unknown
•
Final classification:
1 confirmed; 2=suspected; 3=discarded
•
Mother given protective TT dose within three months of report:
1=yes; 2=no; 9=unknown
•
Supplemental immunization conducted within same locality as the case:
1=yes; 2=no; '-unknown
Recommended data analyses, presentation, reports
Aggregated data (i.e. routine monthly reporting)
•
Incidence rate per 1000 live births by geographic area, month, and year
•
TT2+ (or PAB) by year and geographic area
•
Completeness/timeliness of monthly reporting
•
Geographic areas considered at high risk for NT compared to those where corrective
actions were taken
Case-based data (i.e. from case investigations only) same as for aggregated data
plus the following:
'
•
Confirmed NT cases by delivery type, sex, TT2+ status of the mother
•
% of confirmed cases for which the mother subsequently received a protective TT
dose
16
WHO-recommended standards for surveillance
Neonatal tetanus (continued)
Principle uses of data for decision-making/action
•
Monitor progress towards achieving and sustaining high routine TT2+ (or PAB)
coverage in all geographical areas
•
Monitor progress towards eliminating NT in every geographical area
•
Investigate suspect NT cases in areas not considered at risk for NT to confirm and
determine cause
•
Identify high risk geographical areas
•
Monitor whether corrective actions were taken in those areas considered at high risk
•
Periodically validate sensitivity of NT reporting by comparing number of reported
cases with cases identified through active surveillance
Special aspects
“% protected at birth” (PAB) is an alternative method of determining coverage (particularly
where TT2+ is unreliable). To monitor PAB, health workers record during DTP1 visits
whether the infant was protected at birth by the mother’s TT status and/or delivery status
(clean/unclean). % PAB is then estimated as: number of infants protected/number of live
births. If the child was unprotected, the mother should receive a dose of tetanus toxoid
during the same visit and should be followed up with a subsequent TT dose if needed for
protection.
Contact information
Regional offices
See Annex 1
Headquarters
WHO Global Programme for Vaccines and Immunization (GPV)
(See Annex 1 foraddress/fax number)
E-mail: GasseF@who.ch / GPV@who.ch
Tel:+41 22 791 4414
WHO/EPI/GEN/98.01
17
Pertussis (whooping cough)
Rationale for surveillance
Pertussis is a major cause of childhood morbidity and mortality. An estimated 45 million
cases and 400 000 deaths occur annually. Case fatality rates in developing countries
can reach 15%. High routine coverage with effective vaccine is the mainstay of preven
tion. Surveillance data on the disease can monitor the impact of immunization
programmes as well as identify high risk areas and outbreaks.
Recommended case definition:
Clinical description
A person with a cough lasting at least two weeks with at least one of the following:
1.
Paroxysms (i.e. fits) of coughing
2.
Inspiratory “whooping”
3.
Post-tussive vomiting (i.e. vomiting immediately after coughing) and without other
apparent cause
Laboratory criteria for diagnosis
Isolation of Bordetella pertussis or detection of genomic sequences by polymerase chain
reaction (PCR)
Case classification
Suspected:
A case that meets the clinical description
Confirmed:
A person with a cough that is laboratory confirmed
Recommended types of surveillance
•
Routine monthly reporting of aggregated data of suspected and confirmed cases
from peripheral level to intermediate and central levels. Zero reporting should be
required at all levels
•
All outbreaks should be investigated immediately and laboratory confirmed. During
an outbreak,* case-based data should be collected
>
•
To describe the changing pertussis epidemiology in countries with low pertussis
incidence (usually where coverage is >80%), additional information on age group and
immunization status should be collected; or, as an alternative case-based surveil
lance, sentinel surveillance, active surveillance, and/or occasional surveys and
laboratory confirmation of suspect cases should be considered
Recommended minimum data elements
Aggregated data:
•
•
Number of cases
Number of third doses of diphtheria-pertussis-tetanus vaccine (DTP3) administered
to infants
•
Completeness/timeliness of monthly reports
WHO-recommended standards for surveillance
Pertussis (whooping cough) - (continued)
Case-based data:
•
Unique identifier
•
Geographical area (e.g. district and province) names
•
Date of birth
•
Date of onset
•
Total pertussis vaccine doses:
99=unknown
•
Date of last pertussis vaccine dose:
•
Outcome:
1=alive; 2=dead; 9=unknown
•
Classification:
1 confirmed; 2=suspect; 3=discarded
Recommended data analyses, presentation, reports
Aggregated data:
•
Incidence rate by month, year, and geographic area
•
DTP3 coverage by year and geographic area
•
Completeness/timeliness of monthly reporting
•
Proportional morbidity (compared to other diseases of public health importance)
Case-based data: same as aggregated data plus the following:
•
Age-specific incidence rate
•
Immunization status of cases
•
Case fatality rate
•
Proportional mortality (compared to other diseases of public health importance)
Principle uses of data for decision-making
•
Investigate outbreaks to understand epidemiology of pertussis in the country, why
the outbreak occurred (e.g. failure to immunize, vaccine failure, accumulation of
susceptibles/waning immunity), and to ensure proper case management
•
Monitor case fatality rate. If high, determine cause (e.g. poor case management,
lack of antibiotics/supportive care, patients not seeking treatment in time)
•
Determine age-specific incidence rate, and incidence rate by geographical area to
know risk groups/areas
•
Monitor incidence rate to assess impact of control efforts
WHO/EPI/GEN/98.01
19
Pertussis (whooping cough) - (continued)
Contact information
Regional offices
See Annex 1
Headquarters
WHO Global Programme for Vaccines and Immunization (GPV)
(See Annex 1 for address/fax number)
E-mail: MelgaardB@who.ch / GPV@who.ch
Tel: +41 22 791 4408
WHO-recommended standards for surveillance
20
Poliomyelitis
Rationale for surveillance
Poliomyelitis is targeted for eradication (9GPW 6.1). Highly sensitive surveillance for
acute flaccid paralysis (AFP), including immediate case investigation, and specimen
collection is critical to detect wild poliovirus circulation with the ultimate objective of polio
eradication. AFP surveillance is also critical for documenting the absence of poliovirus
circulation for polio-free certification.
Recommended case definition
Clinical case definition
Any child under fifteen years of age with acute, flaccid paralysis1 or any person with
paralytic illness at any age when polio is suspected.
1
Including Guillain Barre syndrome
Case classification
Suspected case: A case that meets the clinical case definition
Confirmed case: See diagram in special aspects section
Recommended types of surveillance
•
Aggregated data of AFP cases should be included in routine monthly surveillance
reports
•
Zero reporting should be required at all levels
•
All outbreaks should be investigated immediately
•
All AFP cases under 15 years of age or with paralytic illness at an age where polio
is suspected, should be reported immediately, investigated within 48 hours and two
stool specimens collected 24-48 hours apart and within 14 days of paralysis onset
•
Active surveillance should be implemented in selected hospitals
Recommended minimum data elements
Aggregated data:
•
Number of third doses of oral polio vaccine (OPV3) administered to infants
•
Number of AFP cases
Poliomyelitis (continued)
Case-based data (to be linked to specimen-based data for analysis)
•
Unique identifier
•
Geographical area (e.g. district & province) names
•
Date of birth
•
Date of paralysis
•
Date of notification
•
Date of case investigation
•
Total polio vaccine doses received:
99=unknown
•
Fever at onset of paralysis:
1 =yes; 2=no; 9=unknown
•
Progression of paralysis within four days:
1=yes; 2=no; 9=unknown
•
Asymmetric paralysis:
1=yes; 2=no; 9=unknown
•
Date of 60-day follow-up exam
•
Findings at 60-day follow-up:
1 =residual weakness; 2=no residual weakness; 3=lost to follow-up;
4=death before follow-up
•
Final classification:
1 confirmed; 2=compatible; 3=discarded
i
i
Specimen-based data (to be linked to case-based data for analysis)
•
Unique identifier
•
Specimen number:
1=first specimen; 2=second specimen; 3=other; 9=unknown
•
Date of paralysis onset
•
Date of last OPV
•
Date of stool specimen collection
•
Date stool specimen sent to lab
•
Date stool specimen received in lab
•
Condition of stool:
1 =good; 2=poor; 9=unknown
•
Date final culture results sent from lab to EPI
•
Date intratypic differentiation results sent from lab to EPI
22
j
/
i
WHO-recommended standards for surveillance
Poliomyelitis (continued)
•
Results
—
—
-
-
Polio typel isolated?
1=yes, wild; 2=yes, Sabin; 3=yes, pending intratypic differentiation; 4=yes,
mixture of wild & Sabin; 5=no P1 isolated; 6=specimen not processed
Polio type 2 isolated?
1=yes, wild; 2=yes, Sabin; 3=yes, pending intratypic differentiation;
4=yes, mixture of wild & Sabin; 5=no P2 isolated; 6=specimen not processed
Polio type 3 isolated?
1=yes, wild; 2=yes, Sabin; 3=yes, pending intratypic differentiation;
4=yes, mixture of wild & Sabin; 5=no P3 isolated; 6=specimen not processed
Non-polio enterovirus (NPEV) isolated?
1=yes; 2=no NPEV isolated; 3=specimen not processed
Recommended data analyses, presentation, reports
Aggregated data:
•
Cases by month, year, and geographic area
•
OPV3 coverage by year and geographic area
•
Completeness/timeliness of monthly reporting
Case-based data: same as aggregated data plus the following:
•
Confirmed cases by age group, immunization status, geographic area, month and
year
•
Confirmed cases from which wild poliovirus was isolated by geographic area, month,
year
•
Compatible cases by geographic area and month
•
All suspect cases by final classification
•
Non-polio enterovirus isolation rate
•
Indicators of surveillance performance
—
-
|
% of all expected monthly reports that were received
Annualized non-polio AFP rate per 100 000 children
under 15 years of age
% of AFP cases investigated within 48 hours
% of AFP cases with two adequate stool specimens collected
24-48 hours apart and <14 days of onset
% of specimens arriving at the laboratory in “good” condition
% of specimens arriving at a WHO-accredited laboratory within
3 days of being sent
% of specimens with laboratory results sent within 28 days
of specimen receipt
WHO/EPI/GEN/98.01
Target
>90%
>1/100 000
> 80%
> 80%
> 80%
J
> 80%
> 80%
23
Poliomyelitis (continued)
Principle uses of data for decision-making
•
Track wild poliovirus circulation
•
Use data for classifying cases as confirmed, polio compatible or discarded (see
special aspects section)
•
Monitor routine coverage in all geographical areas and focus efforts in low performing
geographical areas
•
Monitor seasonality to determine low season of poliovirus transmission for National
Immunization Day (NIDs) planning
•
Identify high risk areas for planning mopping up immunization
•
Monitor performance of surveillance using standard indicators listed above and focus
efforts in low performing geographical areas
•
Provide evidence to Certification Commissions of the interruption of wild poliovirus
circulation
24
WHO-recommended standards for surveillance
Poliomyelitis (continued)
Special aspects
The scheme in the following illustration (Figure 1) should be used to classify AFP cases.
A country should use the clinical classification until their surveillance performance meets
the following three criteria: 1) a non-polio AFP rate of at least 1 /100,000 children under 15
years of age; 2) two adequate specimens’ collected from at least 60% of detected AFP
cases; 3) all specimens processed in a WHO-accredited laboratory.
Figure 2a: Clinical criteria
(early stages of polio eradication)
I
Figure 2b: Virologic criteria
I
(advanced stages)
I
|
Wild poliovirus
I
residual
weakness,
died or lost
to follow-up
I
compatible2
I
National Expert
I "^Committee
inadequate
specimens
No wild
poliovirus
confirm
j
Review
j
I
no residual
weakness ■ —discard I
discard
■ ■■■■■ O
discard
1 >■
discard
I
I
I
two adequate
specimens
■ ■
,.
,
discard
!
“Adequate specimens” means two specimens collected 24-48 hours apart and
within 14 days of onset of paralysis. The specimen arriving at the laboratory
must be of adequate volume (approximately 8-10 grams), have appropriate
documentation (i.e. laboratory request form) and be in “good condition". “Good
condition” = no leakage, no desiccation, and evidence that the reverse cold
chain was maintained (based on presence of ice or temperature indicator).
“Compatible" cases indicate surveillance failures and should be monitored for
clustering in space and time
Contact information
Regional offices
See Annex 1
Headquarters
WHO Global Programme for Vaccines and Immunization (GPV)
(See Annex 1 for address/fax number)
E-mail: AylwardB@who.ch / GPV@who.ch
Tel: +41 22 791 4406
WHO/EPI/GEN/98.01
25
Yellow fever
Rationale for surveillance
This mosquito-bome virus disease occurs in tropical regions of Africa and South America
and is maintained by sylvatic transmission of virus involving forest-dwelling mosquitoes
and monkeys. Transmission to humans may occur in forest transition zones and subse
quently may enter an urban cycle through the Aedes aegypti mosquito. Many cities are
now threatened with major epidemics as yellow fever is undergoing a major resurgence
especially in the African region. The strategies for yellow fever control are: control of
Aedes aegypti in urban centres, infant immunization, immunization campaigns to prevent
epidemics, epidemic detection and emergency immunization when an epidemic is
confirmed. Surveillance data allows for monitoring disease incidence, the prediction and
early detection of outbreaks and the monitoring of control measures. Case reporting of
yellow fever is universally required by International Health Regulations.
Recommended case definition
Clinical description
An illness characterised by acute onset of fever followed by jaundice within two weeks of
onset of first symptoms AND one of the following: 1) bleeding.from nose, gum, skin,
or Gl tract; or 2) death within 3 weeks of illness onset.
Laboratory criteria for diagnosis
Isolation of yellow fever virus,
or presence of yellow fever specific IgM or a four-fold or greater rise in serum IgG levels
(acute or convalescent)
or positive post-mortem liver histopathology
or detection of yellow fever antigen in tissues by immunohistochemistry
or detection of yellow fever virus genomic sequences in blood or organs by PCR.
Case classification
Suspected:
A case that is compatible with the clinical description
Probable:
Not applicable
Confirmed:
A suspected case that is laboratory confirmed or epidemiologically
linked to a laboratory-confirmed case or outbreak
Recommended types of surveillance
•
Routine weekly/monthly reporting of aggregated data on suspected and confirmed
cases from peripheral level to intermediate and central levels. Zero reporting should
be required at all levels.
•
Immediate reporting of suspected cases from peripheral level to intermediate and
central levels.
•
All suspected cases and outbreaks should be investigated immediately and labora
tory confirmed.
•
Case-based surveillance should be implemented in countries identified by WHO as
high risk for yellow fever. Specimens should be collected to confirm an epidemic as
rapidly as possible. Then priority should be placed on collecting specimens from
new or neighbouring areas (other than the area where the epidemic is already confirmed).
26
WHO-recommended standards for surveillance
Yellow fever (continued)
Note:
There is mandatory reporting to WHO of all suspected and confirmed yellow fever
cases within 24 hours of detection.
Recommended minimum data elements
Aggregated data for reporting
•
Number of cases
•
Doses of yellow fever vaccine administered to infants by geographical area
•
Completeness / timeliness of monthly reports
Case-based data for reporting and investigation
•
Unique identifier
•
Geographical area (e.g. district and province) names
•
Date of birth
•
Date of onset
•
Date of notification
•
Date of investigation
•
Ever received a dose of yellow fever vaccine:
1=yes; 2=no; 9=unknown
•
Date acute blood specimen received in laboratory
•
Date convalescent blood specimen received in laboratory (if applicable)
•
Date histopathology specimen collected (if applicable)
•
Depending on which laboratory tests used:
-
-
IgM results:
1=positive; 2=negative; 3=no specimen processed; 9=unknown
Virus isolation results:
1 =positive; 2=negative; 3=no specimen processed; 9=unknown
IgG (4-fold rise) results:
1 =positive; 2=negative; 3=no specimen processed; 9=unknown
Liver histopathology:
1 =positive; 2=negative; 3=no specimen processed; 9=unknown
•
Date IgM results first sent
•
Date virus isolation results first sent
•
Date IgG results first sent
•
Date histopathology report first sent
•
Final classification:
1 confirmed; 2=suspected; 9=discarded
•
Final outcome:
1 =alive; 2=dead; 9=unknown
WHO/EPI/GEN/98.01
27
Yellow fever (continued)
Recommended data analyses, presentation, reports
Aggregated data
•
Incidence rate by month, year, and geographic area
•
Yellow fever vaccine coverage by year and geographic area
•
Completeness/timeliness of monthly reporting
Case-based data same as aggregated data plus the following:
•
Confirmed cases by age group, immunization status, geographic area, month and
year
Case fatality rate
Final classification of all suspect cases
Performance indicators of surveillance quality
Completeness of monthly reporting
Percent of all suspect cases for which specimens were collected
—
For IgM test: Laboratory results sent < three days of receipt
of acute blood specimen
For virus isolation: Laboratory results sent < 21 days of receipt of
acute blood specimen
For IgG test: Lab results sent < three days of receipt of
convalescent blood specimen
Target
> 90%
> 50%1
> 80%
> 80%
> 80%
This is the target during non-outbreak periods. Once an outbreak is confirmed,
the priority is to detect and laboratory-confirm outbreaks in neighbouring areas.
Principle uses of data for decision-making
•
Investigate suspect cases and collect laboratory specimens to confirm an outbreak
and mobilise emergency immunization activities
•
Monitor yellow fever coverage by geographic region to assess progress towards
outbreak prevention and identify areas of poor performance so that corrective actions
can be taken
•
Monitor incidence rate to assess impact of control efforts
✓
Special aspects
The following 34 countries are at risk for yellow fever epidemics in Africa:
Angola, Benin, Burkina Faso, Burundi, Cameroon, Cape Verde, Central African Republic,
Chad, Congo, Cote d’Ivoire, Democratic Republic of Congo, Equatorial Guinea, Eritrea,
Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Kenya, Mali,
Mauritania, Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Sierra Leone,
Somalia, Sudan, Tanzania, Togo, Uganda. The following countries are at risk for yellow
fever in South America: Bolivia, Brazil, Colombia, Ecuador, Guyana, French Guyana,
Panama, Peru, Suriname, Trinidad and Tobago, Venezuela.
28
WHO-recommended standards for surveillance
Yellow fever (continued)
Contact information
Regional offices
See Annex 1
Headquarters
WHO Global Programme for Vaccines and Immunization (GPV)
E-mail: Neillm@who.ch / GPV@who.ch
Tel:+41 22 791 4693
WHO Division of Emerging and Other Communicable Diseases, Surveillance
and Control (EMC)
E-mail: ArthurR@who.ch
Tel: +41 22 791 2658
WHO/EPI/GEN/98.01
29
Annex 1
WHO headquarters and regional office contacts
WHO Headquarters
WHO Global Programme for Vaccines and
Immunization (GPV)
20 Avenue Appia, CH-1211 Geneva 27, Switzerland
Fax: 41 22 791 4193
Email: GPV@who.ch
EPIdata@who.ch
!
WHO Division of Emerging and Other Communicable
Diseases, Surveillance and Control (EMC)
20 Avenue Appia, CH-1211 Geneva 27, Switzerland
Fax: +41 22 791 4878
WHO AFRO
WHO AMRO
WHO EMRO
WHO EURO
WHO SEARO
WHO WPRO
30
’
(temporary address)
Parirenyatwa Hospital
P.O. Box BE 773
Harare, Zimbabwe
Tel:+263 407 69 51
Email: okwob@server.whoafr.org
;
525, 23rd Street N.W.
Washington D.C. 20037
U.S.A.
Tel:+1 974 3000
Email: QuadrosC@paho.org
,
1
P.O. Box 1517
Alexandria-21511
Egypt
Tel:+203 48 202 23
Email: EPIdata@who.sci.eg
i
8, Scherfigsvej
DK-2100 Copenhagen
Denmark
Tel:+45 39 17 17 17
Email: MCI@who.dk
*
;
|
z
World Health House
Indraprastha Estate
Mahatma Gandhi Road
New Delhi 110002
India
Tel:+91 11 331 7804
Email: EPIdata@who.ch
'
>
P.O. Box 2932
1099 Manila
Philippines
Tel: +632 528 80 01
Email: EPI-Pstaff@who.org.ph
WHO-recommended standards for surveillance
The Global Programme for Vaccines and Immunization, established by the
World Health Organization in 1994, defines its goal as "a world in which all
people at risk are protected against vaccine-preventable diseases'1. The Pro
gramme comprises three units:
Expanded.Programme on Immunization
Vaccine Research and Development
Vaccine Supply and Quality
.
The Expanded Programme on Immunization focuses on the prevention of
selected childhood diseases and, through support to national immunization
programmes, aims to achieve 90% immunizationrcoverage of children born
each year. Its goals^are to eradicate poliomyelitis from the world by the year
2000, reduce measles deaths and incidence, eliminate neonatal tetanus as
a public health problem and introduceiiepatitis B vaccine in all countries.
Vaccine Research and Development supports and promotes researclrand
development associated fljith the introduction of new vaccines into the
Expanded Programme on Immunization. This, includes research and.devek^
opment of new vaccines, improvement of immunization procedures and sup-^
port to epidemiogical studies.
Vaccine Supply, and Quality ensures adequate, quantities of high quality,
affordabl&vaccines for all the world's children, supports the efforts of gov
ernments to become self-reliant as regards their vaccine needs, and assists
in the rapid introduction of new vaccines.
.A
The Global Programme for Vaccines amllmmunization produces arrange of
documents, audiovisual materials and'software'packages to disseminate
information on its activities, programme policies, guidelines and. recom
mendations. It also provides materials for group and/or individual training
on topics ranging fromlrepair of health centre equipment to curricula guide
lines for medical schools, nursing colleges and.training of vaccine/quality
control personnel. ■ 'L
■ -i
■ /*
■
<-■ -
For further information please contact:
Global Programme for Vaccines and Immunization
World Health^rganization • CH-1211 Geneva 27• Switzerland.
Fax^+41 22791 4192/93 • E-mail: GPV@who. ch
U
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