Child survival : accelerated immunization project, grant number CAR-0005-G-00-6971-00 -- mid-term evaluation, final draft

The Pan American Health Organization is implementing the project. Mid-term evaluation covers period 8/86-8/89. In 1988, a provisional total of 361 confirmed cases of polio were reported in the region with 155 probable cases still pending final classification. This provisional total represents a 61% decline from the 930 confirmed cases reported in 1986. The impact of an intensification of surveillance activities in 1986 can be seen from the 48% increase in notification of cases of acute flaccid paralysis region-wide that occurred in 1986 compared to 1985, and the 77% increase in notification in 1988 compared to 1985. Since surveillance was strengthened in 1986, there has been a progressive decline in the incidence of confirmed polio cases reported in the region. It is also interesting to note that for the first time during 1988 there appeared to be a dampening or virtual disappearance of the usual seasonal pattern of polio that had existed, characterized by an increase in polio cases during weeks 10-30. This suggests that transmission of polio has been substantially suppressed. If all subregions are combined, with Brazil and Mexico excluded, a steady increase in OPV3 (polio vaccine) coverage has occurred between 1980 and the peak in coverage in 1988. Because of the problems that exist with the coverage data for Mexico and Brazil during 1980-84, it is reasonable to conclude that the region-wide OPV3 coverage estimate of 82% in 1988 probably represents an all- time high in OPV coverage. Region-wide coverage rates for DPT, measles, and BCG vaccines progressively increased between 1985 (when the Project Plan of Action was devised) and 1988. Coverage rates for all of these antigens reached record high levels in 1988. Provisionally, the estimated coverage rates for 1988 are as follows: OPV3 (82%), DPT3 (59%), measles (64%), and BCG (72%). These data suggest that the Project has influenced the improvement in coverage levels of all EPI antigens, not just with OPV, and has strengthened the overall EPI program. Investments in cold chain equipment and logistics as well as the surveillance and monitoring systems established nder the eradication program also support the EPI effort. However, the goal of achieving coverage levels of greater than 80% in children 0-1 for all EPI antigens is unlikely to be reached by 1990, with the exception of OPV and possibly BCG vaccine. Following upon the improvements in delivery and monitoring infrastructure, emphasis should be placed at the country level on balancing the poliomyelitis eradication effort within the context of the EPI as a whole. For example, poliomyelitis specific activities, such as disease surveillance, should be expanded (as envisioned in the EPI policy and strategic approaches in the Americas) to include other EPI target diseases (especially measles and neonatal tetanus). (Author abstract, modified)