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II



The Depatent of Iniation, Vaccines and

Bioogicas thans the donos whose nspecied

nancia sppot has ade the podction of thispbication possibe.

This pbication was podced b the Epanded

Pogae on Iniation tea of the Wod

Heath Oganiation Depatent of Iniation,

Vaccines and Bioogicas.

Odeing code: WHO/IVB/07.06

Pinted: Novebe 2007

This pbication is avaiabe on the Intenet at:www.who.int/iniation/docents/en

Copies a be eqested fo:

Wod Heath Oganiation

Depatent of Iniation, Vaccines and Bioogicas20, avene Appia

CH-1211 Geneva 27, Switeand

Fa + 41 22 791 4227

Eai : [email protected]



g l o b l f m w o k f o i m m u n i z i o n

m o n i o i n g n d s u v i l l n

G F I M S



The Goba Faewo fo Iniation moni-

toing and Sveiance – GFImS has been joint

deveoped b the Wod Heath Oganiation(WHO) and the Centes fo Disease Conto and

Pevention (CDC) of the united States Heath

and Han Sevices Depatent, in consta-

tion with an mebe States and ini-

ation patnes. These incde the Canadian

Intenationa Deveopent Agenc, the

united Nations Chiden’s Fnd (uNICEF), the

Bi & meinda Gates Fondation, the GAVI

Aiance, the Netheands minist of Heath, the

Goba Fnd, the Nowegian Institte of PbicHeath, the Nowegian Agenc fo Deveopent

Coopeation, the Poga fo Appopiate

Technoog in Heath, the Intenationa red

Coss, the united Nations Fondation, the

united States Agenc fo Intenationa Deveop-

ent, Hib Initiative, the Pneo Acceeated

Deveopent and Intodction Pan (ADIP), the

rotavis ADIP, the Wod Ban Gop and the

WHO Stategic Adviso Gop of Epets on I-

niation.

WHO and CDC wod ie to than a the peope

who have been invoved in the deveopent

of the GFImS fo thei vision, epetise and had

wo.

k n o w l d - 05

g m n s



The foowing abbeviations and acons ae

sed in this docent.

AEFI advese event/s foowing iniation

AFP acte accid paasis

AIDS acqied inodecienc sndoecmyP copehensive mti-yea Pans fo

Iniation

CrS congenita bea sndoe

CSF ceebospina id

DQA data qait adit

DQS data qait sef-assessent

EPI Epanded Pogae on Iniation

GAVI GAVI Aiance

GFImS Goba Faewo fo Iniation

monitoing and SveianceGIVS Goba Iniation Vision and Stateg

Hib Haemophilus infuenzae tpe b

HIV han inodecienc vis

HmN Heath metics Netwo

HPV han papioavis

ICC inteagenc coodinating coittee

Igm inogobin tpe m

IHr Intenationa Heath regations

ImCI Integated manageent of Chidhood

InessIPTi inteittent peventive teatent in infants

(against aaia)

ITN insecticide-teated nets

JE Japanese encephaitis

JrF joint epoting fo

mDG mienni Deveopent Goa

NrA nationa egato athoit

PBmS paediatic bacteia eningitis

sveiance

PCr poease chain eactionrED eaching eve distict

SAGE Stategic Adviso Gop of Epets

SArS sevee acte espiato sndoe

SOP standad opeating pocede

TB tbecosis

uNICEF united Nations Chiden’s Fnd

VPD vaccine-peventabe disease

b b v i i o n s 06

n d o n y m s



x u i v 07

s u m m y



The goba iniation patnes have a

vision of a wod that, b 2010, benets fo an

integated epideioogica, aboato andpogae onitoing netwo dedicated to

optiiing the sveiance of vaccine-

peventabe diseases (VPDs) and onitoing of

iniation pogae pefoance. This

netwo wi povide the high qait infoation

needed to ease the ipact of vaccines and

aiie thei safe, effective and eqitabe se

at cont, egiona and goba eves to edce

o eiinate the bden of VPDs.

In esponse to this chaenge, the Wod Heath

Oganiation (WHO) has deveoped a Goba

Faewo fo Iniation monitoing and

Sveiance – GFImS. The GFImS vision, as

descibed in this docent, is an etension of

the Goba Iniation Vision and Stateg

2006–2015 (GIVS) which specica caed fo the

atication of:

a global plan for reliably monitoring the goals

of the global strategy through an approachthat builds sustainable monitoring capacity

within the country, particularly at the district

level; such a plan would outline a strategic

approach for strengthening coverage moni-

toring, surveillance, and laboratory capacity

for vaccine-preventable diseases by building

on existing systems within countries and, at

the same time, emphasizing high perform-

ance and accuracy.1

Decision-aes need to decide on how best to

inie oe peope against oe diseases,

intodce new avaiabe ife-saving vaccines

and technoogies, and povide othe citica heath

inteventions ding iniation contacts in aanne that wi aiie effectiveness, ipact

on the VPD bden and ense efcienc in

esoce aocation. The need high qait data

on which to base these decisions.

Oganiations that povide fnding to ini-

ation pogaes aso need copehensive,

high qait data on pogae pefoance

and sveiance to ease the ipact of

vaccine se on the VPD bden and jstif theipbic heath investents.

Thee is, theefoe, a apid gowing genc

to povide high qait data to eet these needs.

It is these needs that ae the diving foce be-

hind the coitent to stengthen and epand

the onitoing infastcte of VPD svei-

ance and iniation pogaes.

The goba faewo, as descibed in thisdocent, has two taget adiences:

• cont-eve pogae and sveiance

decision-aes and pannes, and

• oganiations that povide fnding to i-

niation pogaes.

This docent denes and descibes the es-

sentia coponents of the goba faewo,

factos contibting to changes in the VPD

sveiance and pogae onitoing and-

scape, goas and objectives, the anticipatedipact of eaching these goas and aso the

iss of faiing to each the b 2010.

1 GIVS – Global Immunization Vision and Stategy 2006–2015.

Geneva, Wod Heath Oganiation, 2005 (WHO/IVB/05.05), page 64.

http://www.who.int/vaccines-docents/DocsPDF05/GIVS_Fina_EN.pdf

executivesummary | 08



E S S E n t I a l c o M p o n E n t S

o F G F I M S

The needs and ais that copise the goba

faewo incde:

• the need to bing a VPD sveiance and

pogae onitoing togethe into a

boad, nied faewo that ins with, and

bids pon, the stengths and sccesses of

poio sveiance and othe sveiance

sstes aead in eistence;

• the ais to be eached and activities to be

panned to eaie the GFImS vision fo VPDsveiance and pogae onitoing b 2010;

• ecognition of the centa oe of VPD svei-

ance and pogae onitoing in assing

sccessf conto and/o eiination of VPDs.

F a c t o r S c o n t r I b u t I n G

t o c h a n G E S I n t h E

S u r v E I l l a n c E a n D

p r o G r a M M E M o n I t o r I n Gl a n D S c a p E F o r v p D s

The sveiance and pogae onitoing

andscape fo VPDs is ndegoing apid changes

that highight the need: a) to foate a new

coon vision aong iniation patnes,

and b) to give diection to VPD sveiance and

iniation pogae onitoing. These

changes have been shaped b a nbe of factos,

incding:

• inceased ephasis on achieving high

otine iniation coveage (one of the

fo Stategic Aeas of GIVS)2

;• the avaiabiit of new vaccines and nancing

options fo intodction of new vaccines;

• the need to sstain sveiance and po-

gae onitoing to sppot the ongoing

goa of poio eadication;

• new goba goas, sch as the GIVS goa to

edce eases otait b 90 % b 2010

(copaed with 2000) 3;

• new intenationa heath egations that

eqie conties to estabish and aintainsveiance capacit to detect and povide

notication of diseases of goba heath i-

potance; and

• the theat of eeging o pandeic

diseases.

G s d j e i e s

The goba faewo has goas and objectives

at the goba, egiona, nationa and sevice

deive eves, as otined beow.

01 To in epideioogica and aboato

sveiance (whee technica and ogistica

appopiate):

a) fo a VPDs, incding diphtheia, inena,

eases, ps, petssis, poio, bea

and congenita bea sndoe (CrS); and

b) fo diseases sch as Japanese encephaitis

(JE), eningococca eningitis and eow feve

in specic egions.

2 Potecting oe peope in a changing wod, Stategic Aea I. In GIVS – Global Immunization Vision and Stategy

2006–2015. Geneva, Wod Heath Oganiation, 2005 (WHO/IVB/05.05), pages 29–38.

3 GIVS – Global Immunization Vision and Stategy 2006–2015.

Geneva, Wod Heath Oganiation, 2005 (WHO/IVB/05.05), page 26.




02 To povide pogaatic data to onito

ongoing iniation coveage tends and

othe eases of pogae pefoance; tose these data to aintain coveage achieve-

ents and each additiona chiden —

especia the had-to-each and inoit o

disadvantaged popations — thogh

otine and oteach sevices.

03 To povide a sveiance and onitoing

netwo to faciitate the copetion of poio

eadication and cetication, to sppot the

achieveent of the egiona eases eiinationand eases otait edction goas, and to

docent the eiination of neonata tetans.

04 To bid sveiance capacit at cont eve

fo disease bden estiates and ipact

onitoing in pepaation fo new o ecent

intodced vaccines (sch as haemophilus infu-

enzae tpe b [Hib], JE, eningococca conjgate,

pneococca conjgate and otavis), as we

as onitoing of VPDs that ae initia cinicasient, sch as hepatitis B and han papioa-

vis.

05 To epand and in eisting aboato net-

wos fo via and bacteia diseases, incding

the poio and eases aboato netwos

and othe egiona and oca netwos (e.g. the

Paediatic Bacteia meningitis Netwo and

sentine sveiance netwos fo pneo-

cocca and otavis disease), to incde othepioit VPDs (see aso No. 1 above).

06 To in with othe infectios disease svei-

ance and pogae onitoing sstes

b poviding a coon patfo at cont eveon an « as needed » basis fo ea detection and

esponse to non vaccine-peventabe eeging

infections and disease otbeas.

07 To in with othe initiatives to deveop goba

sveiance fo seasona, avian and pandeic

inena to ense the appopiate and tie

se of vaccines in the contet of eeging o

theatening epideics (see aso No. 1 above).

r e i g e g s

The foowing otcoes ae anticipated if

the goba faewo scceeds in eaching the

above goas.

01 B sing sveiance and onitoing data to

info and diect pbic heath action, the

nacceptab high goba disease bden de to

VPDs 4 wi be fthe edced.

02 A oe copeing case can be ade fo a

oe eqitabe distibtion of cent avaiabe

o new vaccines, aead wide sed in the in-

dstiaied wod, to occ in disease-endeic

deveoping conties.

03 B ining the etensive goba VPD svei-

ance netwo with the associated vaccine-

deive infastcte of nationa inia-

tion pogaes, epideics of goba heath

4 It is cent estiated that appoiate 2.5 iion chiden nde ve eas of age die eve ea as a est of

VPDs.




ipotance — sch as seasona and pandeic

inena, epideic eningitis, and othe

infectios disease theats — wi be detectedand apid esponse wi foow.

F i i g e e g s

The iss, if the goas of the goba faewo

fai to be eached b 2010, ae otined beow.

01 Thee wi be insfcient data on which to

ae accate estiates of the VPD bden; the

effects of VPDs wod ths be ndeestiated.

02 Financia and han esoces wod be

sed inefcient.

03 Thee wod be an inabiit to ne-tne po-

gae diection; this wod foce

pogae anages to attept to diect thei

pogaes withot eqisite data.

04 Vaccine ipact wod be poo eased;

this wod est in an ecessive eiance onodeing.

05 Oppotnities to bid nationa and egiona

sveiance and onitoing capacit (e.g.

bacteia disease sveiance netwos) wod

be ost.

06 VPD otbeas wod not be detected ad-

eqate so peventabe cases and deaths cod

occ.

07 Capacit to detect new and eeging agents

wod be decient.

Heath staff in eve distict shod have the

capacit not on to onito pogae and

otine iniation coveage, condct dis-ease-specic sveiance and ipeent

otbea detection and esponse, bt aso to

se the infoation acqied theeb in taing

decisions and ipeenting action.

This docent ephasies the oe that i-

niation pas in stengthening heath sstes

thogh the ovea benets that acce b

biding han esoce capacit, ipoving

ogistics and secing nancia esoces.

The goba faewo focses on two e aeas

that eqie ongoing sppot and epansion:

GFIMS Strategic Area A:

Sveiance of vaccine-peventabe diseases

GFIMS Strategic Area B:

Iniation pogae onitoing.

In each of these aeas, the docent cites theeated GIVS stategies and activities (inset

boes) and descibes the ain coponents of a

fnctioning sste and its basic eqieents.

The e sveiance and pogae onito-

ing activities ae otined in each section as

« ais». These activities st a be incded

and bdgeted fo in nationa copehensive

ti-ea pans fo iniation (cmyPs),

anna pans of action, and poposas ade to

fnding oganiations and patnes.




h G F I M S 12

v i s i o n

The goba iniation patnes have a vi-

sion of a wod that, b 2010, benets fo

an integated epideioogica, aboato andpogae onitoing netwo dedicated to

optiiing the sveiance of vaccine pevent-

abe diseases (VPDs) and onitoing of i-

niation pogae pefoance. This netwo

wi povide the high qait infoation needed

to ease the ipact of vaccines and to

aiie thei safe, effective and eqitabe se

at cont, egiona and goba eve to edce

o eiinate the bden of VPDs.



i n o d u i o n 13



introduction | 14

p u r p o S E o F t h E

D o c u M E n t

A pbic heath intevention pogaes

eqie constant onitoing and feedbac on

pefoance to enabe pogae anages

to onito the qait of pogae pefo-

ance and diect o odif thei inteventions to

eet the changing envionent. Ftheoe,

decisions on the incsion of a new pbic

heath intevention – sch as the intodction

of a new vaccine – eqie citica infoa-

tion on the disease bden and epideioog,as we as the epected cost-effectiveness and

ipact of the intevention itsef. In inia-

tion pogaes, pefoance onitoing is

dependent on two e ites of infoation: a)

vaccination coveage – that is, the nbe of

doses of vaccine deiveed to the taget gop;

and b) disease sveiance data – that is, data

on edction of the disease bden tageted b

the vaccines.

In the na section of the GIVS docent, The

Wa Fowad, the need fo accopaning doc-

ents to GIVS to be deveoped was epessed:

Sevea faewos and instents wi be

needed to tansate the vision and stategies

aid ot in this docent into nationa o

instittiona poic, panning, ipeenta-

tion, onitoing and evaation. These wi

incde … a goba pan fo eiab onito-

ing the goas of the goba stateg thogh

an appoach that bids sstainabe onito-

ing capacit within the cont, patica

at the distict eve; sch a pan wod otinea stategic appoach fo stengthening cove-

age onitoing, sveiance, and aboato

capacit fo vaccine-peventabe diseases b

biding on eisting sstes within conties

and, at the sae tie, ephasiing high

pefoance and accac.5

This docent, descibing the Goba Fae-

wo fo Iniation monitoing and Svei-

ance (GFImS), is a esponse to that need. Withits goba pespective, the goba faewo is

a aing point fo mebe States and i-

niation patnes and donos. It has two taget

adiences:

• cont-eve pogae and sveiance

decision-aes and pannes, and

• oganiations that fnd iniation po-

gaes.

Fo the decision-aes and pannes, thegoba faewo wi ense that the eve of

sveiance eached in goba poio eadication

effots and pogae acceeation is not on

bit on, bt fthe adapted and integated fo

othe VPDs, epideic-pone disease svei-

ance and pogae onitoing.

Fo the fnding oganiations, the goba

faewo wi spp copehensive and high

qait onitoing data on pogae pefo-

5 GIVS – Global Immunization Vision and Stategy 2006–2015. Geneva, Wod Heath Oganiation,

2005 (WHO/IVB/05.05), page 64.



introduction | 15

ance; these oganiations need this infoation

to ease the ipact of vaccine se on the

VPD bden and ths jstif thei pbic heathinvestents.

The objectives of this docent ae otined

beow.

01 To dene a boad vision fo VPD sveiance

and iniation pogae onitoing fo

2010 b:

a) descibing the cent stats, incding the

achieveents and iitations of sveianceand the need to bing a VPD sveiance to-

gethe in a boad, nied faewo that ins

with – and bids on – the stengths and sc-

cesses of poio sveiance and othe svei-

ance sstes aead in eistence;

b) dening: i) the need fo conties to have

accate data on which to base ationa,

data-diven decisions on thei vaccination

pogaes, and ii) the need fo pogae

acceeation and intodction of new vaccines;c) otining standad coponents and dening

e eeents that shod be in pace fo ad-

eqate sveiance and pogae onitoing;

d) descibing the ationae fo biding and

aintaining VPD sveiance and iniation

pogae onitoing capacit at a eves;

and

e) identifing aeas of coaboation and coodi-

nation with othe pbic heath sveiance and

pogae onitoing sstes.

02 To aticate the ais that shod be eached

to eaie the GFImS vision fo VPD sveianceand pogae onitoing b 2010.

03 To act as an advocac too b infoing

patnes, donos and mebe States of the

centa oe of VPD sveiance and pogae

onitoing in assing sccessf conto o

eiination of VPDs.

VPD sveiance and iniation pogae

onitoing have to be viewed in the contet ofthe heath sste – that is, as a pat of ovea

heath sste onitoing and sveiance.

Whie ecogniing this ipeative, this doc-

ent can on povide a genea faewo fo

the age pespective, based on the etensive

epeience gained to date with VPDs.

b a c k G r o u n D a n D

c o n t E x t

The sveiance andscape fo VPDs is chang-

ing apid de to a nbe of factos, incding

those otined beow.

01 Inceased ephasis on otine iniation

coveage. « Potecting oe peope in a chang-

ing wod » is one of the fo GIVS Stategic

Aeas 6. The GIVS goa fo a conties to each

at east 90 % nationa vaccination coveage, with

6 GIVS – Global Immunization Vision and Stategy 2006–2015. Geneva, Wod Heath Oganiation,

2005 (WHO/IVB/05.05) – GIVS Stategic Aea I, page 29.



at east 80 % vaccination coveage in eve dis-

tict (o eqivaent adinistative eve) b 2010,

highights the need to stengthen otine cove-age onitoing at the distict eve. Aong with

initiatives sch as the reaching Eve Distict

(rED) stateg, the ipeentation of stategies

to each this goa eqies accate and tie

pogae onitoing to be in pace.

p e s e r E D s i i

02 Avaiabiit of new vaccines and/o nancing

options fo vaccine intodction. Conties ae

faced with an npecedented aa of new vac-

cines to be intodced. These vaccines a be

eithe aead icensed o at an advanced stage

of deveopent. These factos, togethe with the

nancia sppot fo the GAVI Aiance (GAVI)

fo new and nde-sed vaccine intodction,

ndescoe the need fo conties to deveop

sveiance sstes that ae abe to povidedisease-bden data. Sch data wi enabe

evidence-based decisions on intodction isses

to be ade and the ipact of intodction to be

onitoed. To intodce new poicies fo eisting

vaccines – pooting optia se and etend-

ing coveage to incde additiona age and is

gops – wi eqie that: a) eisting svei-

ance sstes be epanded to incde diseases

pevented b new vaccines, b) aboato net-

wos be stengthened, and c) the capacit toonito the ipact of both new and eisting

vaccines be bit p.

03 The ongoing goba goa of poio eadication.

Despite the advanced stage of poio eadication,

the ongoing high-qait sveiance of acte

accid paasis (AFP) and poio aboatoies

wi need to be aintained nti goba cetica-

tion is achieved, even in the absence of age

nbes of poio cases.

04 New goba goas. To hep achieve and oni-

to the new GIVS eases otait edction

introduction | 16

A docto eaines a ong bo with eg paasis in a acotad in Aga, India. Afte a thoogh phsica eai-nation, she conses the paents on phsica theap andaanges fo a foow-p visit.Cedit: WHO/r. ka

The reaching Eve Distict (rED) stateg addesses co-on obstaces to inceasing iniation coveage sch aspoo qait distict panning and inadeqate onitoing andspevision of heath woes.

Cedit: WHO

B 10/250

C 150/3750

A 400/10000

DistrictHealth Center

HC

1. Area map

3. Work plan

6. Monitoring chart

5. Drop-outs tracking

system

February

MarchApril

Januar y Immuniz at ion r eminder Box

Y ear : 20 0 1

Go for 100%

coverage

4. Stock record

B C G

D T P

O P V

M e a

T T

S y r i n g e s S a f e t y

b o x e s

2. Session plan



goa of 90 % edction in eases deaths b

2010 copaed with 2000, conties need to

stengthen o estabish case-based, aboato-sppoted eases o febie ash iness s-

veiance sstes.

05 New intenationa heath egations (IHr).

The new egations, appoved b the Wod

Heath Asseb 7 in 2005 have enteed into

foce in Jne 2007. These egations stipate

that a singe case of poioeitis de to wid

tpe poiovis, sapo o han inena

cased b a new sbtpe st be epotedto WHO. Ftheoe, if othe VPDs, sch as

eow feve o eningococca disease, consti-

tte a pbic heath eegenc of intenationa

concen (based on an agoith given in Anne

2 of the Intenational Health regulations 2005 8),

WHO shod be notied. The new IHr eqie

that State Paties estabish and aintain coe

capacities fo sveiance (at the oca, inte-

ediate and nationa eves) abe to detect and

povide notication of diseases of goba heathipotance. The IHr on sveiance, Atice 5.1,

states that:

Each State Party shall develop, strengthen

and maintain, as soon as possible but no

later than ve years from the entry into force

of these Regulations for that State Party, the

capacity to detect, assess, notify and report

events in accordance with these Regulations,

as specied in Annex 1.

Conties and egions have aead stated to

ipeent the IHr b assigning nationa and

egiona IHr foca points and evising gideines

and pans fo assessents of nationa svei-

ance sstes. As pogess is ade fo nationa,

egiona and goba sveiance and onitoing

sstes to eet the IHr eqieents, t-a benecia oppotnities eege fo coabo-

ation in the concoitant stengthening of VPD

sveiance and onitoing, and the povision

of gidance to conties.

06 The theat of eeging o pandeic diseas-

es. With the incease in theat fo diseases,

sch as sevee acte espiato sndoe

(SArS) and pandeic inena, the abiit to

ca on sveiance ofces posted at the gass-oots eve wi be citica to ea-case nding,

notication and apid esponse.

07 mtipe patnes and donos. Given the fac-

tos above, patnes and donos ae inceasing

thei eqests fo ega pogae onito-

ing and sveiance infoation on pogess

in VPD conto. Sepaate channes of etena

and specied sveiance fnding fo espective

VPDs can ceate ibaances and fnding gapsfo coss-ctting fnctions. A nied vision of

VPD sveiance and onitoing – endosed b

patnes and donos – wod incease efcienc

and hep identif fnding gaps.

These changes in the sveiance and onito-

ing andscape a highight the need to foate

a new vision that is coon to iniation

patnes and gives diection to VPD sveiance

and iniation pogae onitoing. Theintepa of diffeent cicstances and tends,

ftheoe, povides a copeing incentive to

tae steps towads an integated sveiance

faewo.

introduction | 17

7 Wod Heath Asseb resotion WHA58.038 Intenational Health regulations 2005 can be fond at http://www.who.int/cs/ih/IHrWHA58_3-en.pdf



Ove the past decade, consideabe pogess has

been ade in estabishing goba, egiona and

nationa sstes fo VPD sveiance, incdingetensive aboato netwos and iniation

pogae-pefoance onitoing, sch as

the WHO/uNICEF Joint repoting Fo (JrF)

and egiona iniation onitoing sstes.

These sstes have been instenta in eas-

ing and/o estiating vaccination coveage

and the ipact of iniation on the goba

VPD disease bden. The have aso povided

citica data to: a) gide pbic heath poic, b)

assess the ipact of stategies, and c) infoiniation pogae adjstents and

ipoveents.

The pogess achieved has been sppoted, in

age pat, b sbstantia aonts of tageted

han and nancia esoces fo the poio

eadication and eases-otait edction

initiatives.

This sppot has been piai concentatedat the nationa and sb-nationa eves in ess

deveoped conties whee eisting infastc-

tes ae weaest, both in tes of pogae

onitoing and ipeentation. The goba

and egiona disease sveiance netwo has

geneated ccia infoation fo sccess-

f giding these VPD-specic initiatives; on a

iited basis it has aso sppoted the detection,

pevention and conto of epideics of diph-

theia, haeohagic feves (Eboa, mabg),eningitis, bea, and vecto-bone diseases

sch as denge and eow feve. moe ecent,

this netwo has seved as a st ine of defence

fo ea detection, esponse and investigation of

otbeas of avian inena.

S u r v E I l l a n c E a n D p r o -

G r a M M E M o n I t o r I n G G o a l S

The goas and objectives fo the goba, egiona,

nationa and sevice deive eves ae otined

beow.

01 lin epideioogica and aboato svei-

ance whee technica and ogistica appo-

piate:

a) fo a VPDs, incding diphtheia, inena,

eases, ps, petssis, poio, bea and

CrS; andb) fo diseases sch as JE, eningococca

eningitis and eow feve in specic egions.

02 Povide pogaatic data to onito ongo-

ing iniation coveage tends and othe

eases of pogae pefoance; se

these data to aintain coveage achieveents

and each additiona chiden – especia the

had-to-each and inoit o disadvantaged

popations – thogh otine and oteachsevices.

03 Povide a sveiance and onitoing

netwo to faciitate the copetion of poio

eadication and cetication, to sppot the

achieveent of the egiona eases eiination

and eases otait edction goas, and to

docent the eiination of neonata tetans.

04 Bid sveiance capacit at cont evefo disease-bden estiates and ipact oni-

toing in pepaation fo new o ecent into-

dced vaccines (sch as Hib, JE, eningococca

conjgate, pneococca conjgate and ota-

vis), as we as onitoing of VPDs that ae

initia cinica sient, sch as hepatitis B and

han papioavis.

introduction | 18



05 Epand and in eisting aboato netwos

fo via and bacteia diseases, incding the

poio and eases aboato netwos andothe egiona and oca netwos (e.g. the Pae-

diatic Bacteia meningitis Netwo and senti-

ne sveiance netwos fo pneococca and

otavis disease), to incde othe pioit VPDs

(see aso No. 1 above).

06 lin with othe infectios disease svei-

ance and pogae onitoing sstes b

poviding a coon patfo at cont eve

on an « as needed » basis fo ea detection andesponse to non-vaccine peventabe eeging

infections and disease otbeas.

07 lin with othe initiatives to deveop goba

sveiance fo seasona, avian and pandeic

inena to ense the appopiate and tie

se of vaccines in the contet of eeging o

theatening epideics (see aso No. 1 above).

r e i g e g sThe foowing otcoes ae anticipated if the

goba faewo scceeds in eaching the

above goas.

01 B sing sveiance and onitoing data

to info and diect pbic heath action, the

nacceptab high goba disease bden de to

VPDs 9 wi be fthe edced.

02 A oe copeing case can be ade fo aoe eqitabe distibtion of cent avaiabe

o new vaccines, aead wide sed in the

indstiaied wod, to occ in disease-ende-

ic deveoping conties.

03 B ining the etensive goba VPD svei-

ance netwo with associated vaccine deive

infastcte of nationa iniation po-

gaes, epideics of goba heath ipo-

tance – sch as seasona and pandeic in-

ena, epideic eningitis, and othe infectios

disease theats – wi be detected and apid

esponse wi foow.

F i i g e e g sThe iss if the goba faewo fais to each

the above goas b 2010 ae otined beow.

01 Thee wi be insfcient data on which to

ae accate estiates of the VPD bden; the

effects of VPDs wod ths be ndeestiated.

02 Financia and han esoces wod be

sed inefcient.

03 Thee wod be an inabiit to ne-tne

pogae diection; this cod foce po-

gae anages to attept to diect thei

pogaes withot the eqisite data.

04 Vaccine ipact wod be poo eased; this

cod est in an ecessive eiance on odeing.

05 Oppotnities to bid nationa and egiona

sveiance and onitoing capacit (e.g. bacte-ia disease sveiance netwos) wod be

ost.

introduction | 19

9 It is cent estiated that appoiate 2.5 iion chiden nde ve eas of age die eve ea as a est of

VPDs.



06 VPD otbeas wod not be detected ad-

eqate so peventabe cases and deaths cod

occ.

07 Capacit to detect new and eeging agents

wod be decient.

G u I D I n G p r I n c I p l E S

Gidig iie 1: Iegig gmme

miig d vpD seie i e

e ssems e

Disease sveiance and pogae onito-

ing ae an intega coponent of the heath

sste and, as sch, ae affected b the baies

and chaenges to the heath sste as a whoe.

The heath sste’s abiit to deive a sev-

ice sch as iniation is often constained

b a nbe of baies that ae enconteed

thoghot the heath sste. moeove, dis-

ease sveiance and pogae onitoing

theseves affect the heath sste and, whenthe do not fnction we, can have a secto-

wide detienta ipact. A e coponent of

endeavos to ipove onitoing and svei-

ance is to eiinate o aeviate these baies.

Fndaenta sste-wide baies which

diect affect the qait of disease sveiance

and pogae onitoing incde:

• inadeqate phsica stctes, eqipent

and sppies;• decient infoation coection and tans-

ission sstes;

• sevee han esoce shotages;

• a ac of poitica and/o nancia

coitent;

• inadeqate qait assance and accedita-

tion echaniss fo aboatoies.

Whie disease sveiance and pogae

onitoing benet fo an effective heath ss-

te, the can contibte to the stengthening ofthe sste b aeviating infoation obstaces

within it.

One of the e sste-wide baies is the

sevee shotage of han esoces de to the

ac of otivated, tained, spevised and ade-

qate paid heath staff. Effective panning, se

and anageent of han esoces in VPD

sveiance and pogae anageent can

contibte to the heath sste as a whoe. Thiscan be achieved b investing in capacit-biding

fo the han esoces at distict and heath

faciit eves, b capitaiing on investents

aead ade in poio eadication, and thogh

a secto-wide appoach that ins and coabo-

ates with othe pbic heath inteventions.

Integating pogae onitoing and VPD

sveiance in the heath sste contet aignswith GIVS Stategic Aea III – to integate i-

niation, othe ined heath inteventions

and sveiance in the heath sstes contet.

Stategic Aea III ephasies the oe of i-

niation in stengthening heath sstes

thogh the benets that acce to the whoe

sste as a est of biding han esoce

capacit, ipoving ogistics and secing

introduction | 20

long-asting insecticida nets povide potection againstaaia.Cedit: WHO/S. Hoan



nancia esoces. This heath sste based

appoach deives nationa iniation

pogaes with a geat potentia to contibteto the achieveent of mienni Deveopent

Goa Fo (mDG 4).

Gidig iie 2: ci-idig dis-

i d e fii ees

As entioned nde Giding pincipe 1 above,

investing in han esoces thogh capacit-

biding can signicant contibte to the a-

eviation of one of the e sste-wide baies.This investent shod be ade at a eves

thogh it is ost citica at the distict and

heath faciit eves. This is becase, in ost

conties, the heath woes at the distict and

heath faciit eves ae the st contact with

the conit – it is the who deive sevices,

povide heath infoation and obtain feedbac

fo the conit.

Eve distict shod theefoe have the capac-it to condct pogae and otine coveage

onitoing, disease-specic sveiance, and

detect and espond to otbeas. The ipo-

tance of capacit-biding at the oca eve is

ndescoed in the 2005 IHr whee the capacit

to detect, epot and iediate ipeent

peiina conto eases at the oca co-

nit and heath faciit eves is dened as

one of the coe capacit eqieents.

Nationa pogaes wi be oe effective if

peiphea opeating nits (distict teas and

heath faciities) ae abe to se infoation fo

action and decision-aing to ipove coveage

and onito ipact and pogae anage-

ent.

Effective taining, spevision and otivationa

stategies fo anageent of han esoces

ae theefoe citica at the distict and heathfaciit eves.

GIVS Strategy 12: Improve management of human

resources

• Invento han esoce needs and deteine

how eisting tained iniation pesonne can

best contibte thei sis and epeience to new

iniation and heath sstes goas, and en-

gage nongovenenta oganiations and thepivate secto in the deive of iniation.

• Pan fo and povide sfcient, adeqate paid

and tained han esoces and atch han

and nancia esoces to acta pogae needs.

• Thogh ipoved and sece iving and woing

conditions, taining and incentives (incding

caee advanceent, ipoved saaies and fai

sppot), otivate heath woes in inaccessibe

o insece aeas to each a eigibe popations.

• Ense that sppotive spevision to these heathwoes is esoced, pioitied, eiab con-

dcted and onitoed.

Gidig iie 3: assig qi d

Athogh sveiance is a eans to onito a

disease conto pogae, the sveiance

sste itsef shod aso be onitoed and

evaated ove tie, as shod othe coss-

introduction | 21

A atena and neonata ot qait assance (lQA) tainingsession in West Benga, IndiaCedit: WHO/J.Vandeae



ctting heath sste isses. monitoing of the

sveiance sste invoves ega eviews of

its pocesses and objectives to ense that theeet sveiance needs and that these needs

ae cea dened and appopiate.

It is aso ipotant to ega coect sste

onitoing infoation on seected indicatos in

the foowing ve e aeas that incopoate the

coe fnctions of sveiance:

• detection and notication capacit,

• data sstes and conications,

• event-based investigation, veication andis anasis,

• aboato pocienc and acceditation, and

• anageia/sppotive activities (e.g. tiei-

ness and copeteness).

The data qait adit (DQA) deveoped with GAVI

sppot to fthe assess the qait of data

within the otine pogae epoting sste

has been epanded b WHO into a data qait

sef-assessent (DQS) ethodoog. The DQSaows conties to diagnose constaints within

thei epoting sstes and identif appopiate

eedia steps.

Gidig iie 4: lige wi e s-

eie d miig ssems

Sevea sveiance and onitoing fnctions

– detection, anasis, data anageent, ana-

sis and epoting – ae coon to a heathpogaes. linage with othe sstes to

stengthen sveiance and onitoing aes

sense since it can edce dpication, tie and

cost whie inceasing the efcient se of the

often iited han and nancia esoces

and phsica stctes. linage shod neithe

copoise the qait of VPD sveiance no

ove-bden eisting heath sstes. B con-

tast, inage shod be appopiate and efcient

and povide « added vae » to achieve ta

benet.

GIVS Strategy 13: Assess and develop appropriate

interventions for integration

• At the goba eve, deveop standadied ethods

fo onitoing and evaating the efcienc, effec-

tiveness and ipact of cobined inteventions, and

adapt the fo se at the distict and sevice

deive eve.

GIVS Strategy 14: Maximize the synergy from inte-

grating interventions• monito and evaate the inceenta efcienc,

effectiveness and ipact of cobined inteventions

and thei eans of deive; app these ndings

in ode to continos ipove the cobined in-

tevention, incease the ange of joint inteventions,

and contibte to ong-te nancia sstainabiit.

GIVS Strategy 15: Sustain the benets of integrated

interventions

• Estabish joint nancing, onitoing and evaa-

tion fnctions.• Poo the esoces needed to cove opeationa

and othe costs.

• Advocate fo fthe sneg and epoe addi-

tiona inages

l i g e w i e v p D s e i -

e d m i i g e f f s

The diffeent coponents of VPD sveiance

shod be consoidated and integated at a

eves nde a boad, nied faewo; thisshod incde integation with eisting svei-

ance sstes. linage that bids on the -

nancia, han and infastcta investents

aead ade fo poio eadication is the ost

obvios step to tae. In an conties – patic-

a ow-incoe and east-deveoped con-

ties whee disease-sveiance sstes ae

not f deveoped – AFP sveiance sstes

introduction | 22



have been epanded to epot on othe VPDs

incding eases, neonata tetans and eow

feve. An eape of this is the integated dis-ease sveiance (IDS) in Afica. As discssed

beow, (nde GFImS Stategic Aea A, Stats)

the poio aboato netwo at cont, egiona

and goba eves seved as the bacbone in the

estabishent of eases/bea aboato

capacit. Both the poio and eases aboato

netwos can be fthe epanded to incde

aboato investigation of othe VPDs. The data

anageent and conication coponents

of the poio and eases sveiance sstescan aso seve as the fondation fo a oe

incsive sveiance sste. An eape of

ining sveiance netwos wod be to in

JE with poio and eases/bea. Svei-

ance of acte encephaitis sndoe fo JE has

stong paaes with AFP sveiance fo poio;

the eases/bea aboato netwo can be

capitaied on to povide seoogica conato

testing fo sspected JE cases. lining the thee

sveiance pogaes pesents an oppot-nit to incease efcienc.

l i g e w i - v p D s e i f i

s e i e d m i i g

VPD sveiance and onitoing shod be

ined to pioit heath pogaes, incding

those deaing with diseases with edi-te

and ong-te pospects fo pevention with

new o ipoved vaccines (edi-te pos-

pects eated to aaia; ong-te pospectsto han inodecienc vis [HIV] and

tbecosis [TB]). linage povides enoos

oppotnities to each at east thee mDGs on

tie – i.e. mDGs 4 and 5 eated to edction of

chid and atena deaths and mDG 6 on edc-

tion of the HIV, TB and aaia bdens. lin-

age can ipove sveiance and onitoing

pogaes b ipoving: a) the anageent

of sveiance infoation fo new vaccines,

and b) otbea detection and esponse.

Coodination and coaboation with those

invoved in pandeic pepaedness at the goba

eve is essentia to haonie activities and

pevent the dpication of effot.

A ve rED coponents – e-estabishing

oteach sevices, ining with conities,

spevision, se of data fo action and distict

esoce panning – invove the se of svei-

ance and onitoing data. Coaboation withothe pogaes in the ipeentation of

data-eated coponents of an integated rED

stateg – that incdes aaia and chid s-

viva inteventions – has the potentia to ipact

on chid otait and the achieveent of mDG

chid-sviva goas.

GIVS Strategy 24: Include vaccines in global epi-

demic preparedness plans and measures

• maintain an effective sveiance sste ined tothe Goba Aet and response Netwo enabing the

appopiate and tie se of vaccines in the contet

of eeging o theatening epideics, and shae

infoation goba.

Oteach sessions and inage with coni-

ties ae two rED stateg coponents with

a high potentia ipact. In an conties,

oteach sessions povide 40–60 % of the chid-

hood iniations. Oteach sessions eachpopations with the owest eve of heath

sevices and shod incde scheded visits

to deive pbic-heath inteventions sch as

insecticide-teated nets (ITNs) and inteittent

peventive teatent in infants (IPTi) fo aaia,

and vitain A sppeentation and antihein-

thics fo chid sviva. In addition, oteach

sessions povide an eceent oppotnit to co-

introduction | 23



W h o l a b s / I n s t i t u t e s t e s t i n

g f r :

P o l i o o n l y ( 2 2 )

m e a s l e s / u b e l l a o n l y ( 5 4 3 )

P o l i o a n d e a s l e s / u b e l l a ( 1 0 9 )

m e a s l e s

/ u b e l l a a n d y e l l o w f e v e ( 1 4 )

P o l i o ,

e a s l e s / u b e l l a a n d y e l l o w f e v e ( 1 3 )

P o l i o a n

d / o e a s l e s / u b e l l a a n d J E

G b a v a c c i n e - p r e v e n t a b e d i s e a s e s a b r

a t r y n e t w r k

A s o f A u g u s t 2 0 0 7 , t

h e g l o b a l v a c c i n e - p e v e n t a b l e d i s e a s e s

( V P D ) l a b o a t o y n e t w o k h a s 6 7 8 l a b o a t o i e s w o l d w i d e .

T h i s n e t w o k h a s t h

e c a p a c i t y f o t h e d i a g n o s t i c t e s t i n g o f

p o l i o , e a s l e s , y e l l o w

f e v e , u b e l l a , a n d

J a p a n e s e

e n -

c e p h a l i t i s . I n a d d i t i o

n , a n u b e o f t h e s e V P D

l a b o a t o i e s

h a v e u s e d t h e b e a d

t h o f t h e i d i a g n o s t i c c a p a c i t y t o i d e n -

t i f y

u n k n o w n

v i u s e

s , i n c l u d i n g

t h e

v i u s

c a u s i n g

S A r S .

T h e

b o u n

d a r i e s a n

d n a m e s s h o w n a n

d t h e

d e s i g n a

t i o n s u s e

d o n

t h i s m a p

d o n o

t i m p

l y t h e e x p r e s s i o n o

f a n y o p

i n i o n w

h a

t s o e v e r o n

t h e

p a r t o

f t h e

W o r l d

H e a

l t h



ect and eaine conit infoation abot

popations that have the highest-otait andowest-coveage ates fo EPI and othe chid

sviva pactices and inteventions. The rED

coponent – ining with conities – po-

vides an oppotnit to discss data intepeta-

tion based on conit data coected ding

oteach and ed sessions.

Iniation pogaes shod aso inte-

face and coaboate with the Heath metics

Netwo (HmN), a ajo WHO faewo fo

stengthening sveiance and heath infoa-

tion sstes at the cont eve and, when ap-

popiate, with acadeic centes of eceence.

The atte can be a vaabe esoce not on

fo taining and stengthening capacit bt asofo poviding data that is sef in ndestanding

the epideioog and bden of a oca disease.

GIVS Strategy 19: Provide access to immunization

services in complex humanitarian emergencies

• Incde vaccine-peventabe diseases in inte-

gated sveiance and onitoing sstes es-

tabished in esponse to cope eegencies.

l i g e w i e i e - s e

e eIn conties with a signicant popotion of

pivate-secto heath cae and iniation

sevices, inage with the pivate secto to

obtain coveage data, fo eape, is citica.

In ost conties, the pivate secto heath

povides pa an ipotant oe in VPD case

detection. This secto of the heath cae sevices

has to be engaged in copehensive disease

sveiance fo the f etent of the disease

bden to be peceived. The eans have tobe fond fo pivate cinicians and othe

heath cae povides to: a) povide ega

pdates on VPD sveiance and pogae

onitoing, and b) epot appopiate and

ega to the pbic heath pogae.

Gidig iie 5: assig i ss-

iii

GIVS Strategy 21: Ensure adequate and sustainablenancing of national immunization systems

• Stengthen nationa capacit fo nancia panning

both within the iniation pogae itsef

and the inist of heath as a whoe.

• Coodinate iniation nancing thogh the

Inteagenc Coodinating Coittees to ense

adeqate and appopiate dono sppot to na-

tiona govenents.

Soid and sstainabe nancing is eqied toense continos avaiabiit of a data needed

to achieve cent and fte iniation

goas of disease sveiance and pogae

onitoing.

Sbstantia nancia sppot fo iniation

pogae onitoing and VPD sveiance

shod be, piai, the esponsibiit of nation-

introduction | 25

mobie vaccination teas visit pas, bs and aiwa sta-tions, as we as ive and sea teinas to vaccination steetchiden and othe high-is popations who a not attendschoo o do not have access to conit vaccination sites.Cedit: Aeican red Coss



a govenents who shod be ged to povide

this sppot in a sstainabe wa. Etena sp-

pot – povided thogh we-coodinated andefcient investents in onitoing and svei-

ance sstes – is needed ain in the ow-

est incoe conties. In soe cases etena

sppot is eqied to jp-stat sveiance

activities. An ipotant isse is to nd a sitabe

baance between the aocation of esoces fo

biding anageent infoation sstes that

incde sveiance and onitoing at nationa

and distict eves, and esoces fo sstes

that pefeentia benet goba and eseachpespectives, e.g. high-cost sves and « high-

science » sentine sites/stdies.

The intenationa patnes cent sppoting

vaccination pogaes goba shod povide

gidance to conties on the incsion of VPD

sveiance as a standad coponent of thei

ti-ea pans, bdgets, poposas, and GAVI

appications. The objectives ae: a) to ense

that sveiance fo new vaccines is initiated asa standad pactice befoe the vaccine is into-

dced, b) to povide baseine infoation on dis-

ease bden, and c) to contine sveiance to

evaate ipact foowing vaccine intodction.

maintaining, ipoving and epanding goba

sveiance and onitoing capacit fo VPDs

and the iniation pogae wi on be

possibe with contined intenationa coit-

ent to ense the necessa nancia sppotfo epanding han esoces and aboato

capacit, as eqied. The copaative sa

investent in sveiance and onitoing ss-

tes is an ipotant peeqisite to ense that

the ain inteventions – otine and sppe-

enta vaccination activities – have the desied

ipact, ae we-gided and efcient ipe-

ented. Goba poio eadication has shown that

it is possibe to bid an efcient goba svei-

ance sste in esoce-poo conties at ea-

tive inia cost copaed to the cost of theintevention itsef. Goba VPD sveiance and

onitoing effots, patica in ow-incoe

deveoping conties, have inceasing been

stained b epectations and deands to epand

eisting sstes to incopoate sveiance

fo the intodction of new vaccines. Eisting

VPD sveiance sstes ae aso epected to

seve as a patfo fo detection and esponse

to eeging infectios disease theats, sch

as avian inena. Howeve, these additionaepectations have not as et been baced p b

additiona esoces.

introduction | 26



o u t l I n E o F S t r a t E G I c

a r E a S

The goba faewo has two e stategic a-

eas that eqie ongoing sppot and epansion.

GFIMS Strategic Area A:

Sveiance of vaccine-peventabe diseases

GFIMS Strategic Area B:

Iniation pogae onitoing

Fo each of these aeas, this docent cites the

eevant GIVS stategies and activities and de-scibes the ain coponents and basic eqie-

ents fo a fnctioning sste. The « ais »

isted in each section ae e sveiance and

onitoing activities and shod be incded and

bdgeted fo in nationa copehensive cmyPs,

in anna pans of action and in poposas ade

to fnding oganiations and patnes.

introduction | 27



G F I M S 29

S g i a aS u v i l l n o f v i n - p v n b l d i s s s



GFIMSstrategicareaA | 30

GIVS Strategy 16: Strengthen monitoring of cover-

age and case-based surveillance

• Epand the eisting sveiance sstes (sch aspoio and eases sveiance) in ode to

pogess towads effective case-based svei-

ance fo vaccine peventabe diseases, i.e., both

eisting vaccine peventabe diseases and dis-

eases fo which vaccines ae anticipated.

GIVS Strategy 17: Strengthen laboratory capacity

through the creation of laboratory networks

• Epand the eisting aboato netwos (incding

the poio and eases aboato netwo and othe

egiona and oca netwos sch as the PaediaticBacteia meningitis Netwo and the netwos

estabished b GAVI’s Acceeated Deveopent and

Intodction Pans fo pneococca and otavis

vaccines) to incde othe pioit diseases.

• Asse the taining, eqipent, eagents and

qait conto pocedes needed to sstain

high qait diagnostics fo a vaccine-pevent-

abe diseases and othe pioit diseases.

• At the goba eve, deveop new diagnostic tests,

toos and pocedes to ipove both ed-basedand aboato conation of diagnoses.

GIVS Strategy 18: Strengthen the management,

analysis, interpretation, use and exchange of data at

all levels

• rega eview distict indicatos of pefo-

ance, incding is stats fo vaccine-peventabe

diseases and se sveiance and onitoing

data to advocate fo ipoved access to, and

qait of, iniation.

• monito the qait and pefoance of coveageonitoing and sveiance sstes thogh

sves, onitoing of pefoance indicatos,

data qait assessents, disease odeing and

sppotive spevision.

c o n t E x t a n D

b a c k G r o u n D

It is citica to have an effective disease svei-

ance sste fo pogae panning, pioit

setting, esoce obiiation and aocation.

Disease sveiance has an pposes, in-

cding:

• estabishing the VPD bden;

• onitoing pogess towads disease

eadication, eiination and/o conto goas;

• assing apid detection and esponse to

disease events of pbic heath concen;• docenting shot-te and ong-te

effects of vaccination on disease bden

and epideioog, theeb onitoing

pogae effectiveness;

• detecting shifts in tpes o sb-tpes of

oganiss casing disease.

In ost cases, VPD sveiance sstes a-

ead eist fo diseases tageted b the tadi-

tiona EPI vaccines10

. Howeve, these sstesneed to be aintained, ipoved, and epanded

to eet the inceased deand fo accate

disease-bden data and vaccine ipact data.

In aeas whee VPD sveiance is goba

inadeqate – fo eape, in the sveiance

of bacteia invasive disease – the sstes

have to be not on goba conceptaied with

inpt fo egions and mebe States, bt aso

ceated, fnded and epanded; this a tae

sevea eas.

A e coponent of sveiance is to onito

ipact of iniation on disease incidence.

10 BCG, DTP, eases and poio vaccines.




tie data fo decision-aing and action.

Paticipating aboatoies – pefeab pbic

heath aboatoies athe than aboatoies inacadeic instittions – have a dened oe in

VPD conto and pevention; the have stong

ins to inisties of heath, iniation po-

gaes and WHO. Efcient qait-assance

pogaes ae e factos in assing sensi-

tive aboato-based sveiance, paticipation

and copiance with anna WHO acceditation

pocesses and pocienc testing. Netwo

aboato staff st be tained to se goba

standadied tests and pocedes. Netwoaboatoies st be ndepinned b goba

epet-efeence aboatoies that povide the

tiate epet technica nowedge. The goa

fo ost diseases is fo eve cont to have

a pocient nationa aboato that can poc-

ess both vioogica and bacteia speciens.

Sa conties, whee this a not be possibe,

shod have access to sch a sevice.

most vaccines ie to be intodced within the

deveoping wod in the coing ve eas wi

povide potection against diseases that have

an appopiate sveiance sste, based at a

aboato sentine site, to detect specic

pathogens associated with diffeent cinica sn-

Fo this, eiabe epideioogica data (e.g. case–

fatait atios, incidence ates and seopevaence

data) ae needed. The specic data eqieentsae, howeve, dependent on the nate of the

disease and the odeing appoach sed.

Deveoping odes and pocesses to estiate

disease bden and onito the ipact of i-

niation on disease bden is a sef ee-

cise in itsef as the pocess eqies the estab-

ishent of disease-edction goas that need

to be onitoed. Ftheoe, the goba and

egiona bden of disease estiation is a edecision-aing coponent fo WHO in aing

ecoendations on vaccine intodction and

in pepaing investent cases to faciitate dono

decisions in sppot of vaccine intodction in

eigibe conties. Athogh odeing povides

citica infoation, it is ipotant that sensitive

sveiance sstes be deveoped to ense

that the iniation stateg accopishes

the objectives fo which it has been designed –

that is, that it has an ipact on disease bden.

GIVS Strategy 8: Strengthen country capacity to

determine and set policies and priorities for new

vaccines and technologies

• Stengthen cont capacit to assess disease

bden and the cost and cost-effectiveness of new

vaccines and technoogies thogh the se of

standad toos.

linage with othe sveiance and onitoingsstes is highighted as a giding pincipe

(see above, Guiding pinciple 4). Biding on

sstes that aead eist asses an incease

in efcienc and effectiveness, with bette coo-

dination and infoation-shaing.

The aboato, a citica coponent of VPD

sveiance, is needed to povide accate and

Accedited aboatoies of assed qait ae citica fo the

conation and oeca chaacteiation of vaccine-peventabe diseases.Cedit: WHO




dessed thogh onitoing of iniation

injection sppies, vaccine stoage and pepa-

ation pactices, as we as thogh svei-ance of advese events foowing iniation

(AEFI). AEFI sveiance enses tie action

to addess ea and peceived vaccine-safet

concens that cod othewise have a potentia

negative ipact on vaccination coveage. AEFI

sveiance aso aows fo the coection of

qantitative data that can be sed to assess the

oe of safet concens when coveage is beow

taget.

GIVS Strategy 5: Improve vaccine, immunization and

injection safety

• Estabish sveiance and esponse to advese

events foowing iniation, both fo eisting

vaccines and fo new vaccines as the ae

intodced into nationa schedes.

• Be esponsive to potentia vaccine safet isses

and addess these gent.

S t a t u S

B vite of teendos poitica and nan-

cia coitent ove the past 25 eas, the

poio eadication initiative has ade a age

investent in stengthening iniation and

sveiance sstes (both in the infastc-

te and at a han eve). The eisting poio

ed and aboato sveiance netwos ae

essentia to the accopishent of eadication

and cetication; the st be aintained nticetication – fo the net ve eas at east o

even beond – in ode to eet the sveiance

qait standads set ot b the poio eadication

initiative and the goba and egiona cetica-

tion coissions. This peiod epesents an

oppotnit, not on fo poio sveiance to be

epanded to incde sveiance of othe VPDs

bt aso fo othe acceeated disease-conto

does. Sentine sites povide decision-aes

with evidence/disease bden infoation that:

a) sppots decisions on vaccine intodctionagainst these diseases, and b) seves as a basis

fo onitoing the ipact of these vaccines.

Idea, two to thee eas’ woth of baseine

data ae eqied to itigate season-to-season

and ea-to-ea vaiabiit in disease incidence.

Appopiate sentine-disease sveiance

shod theefoe pecede vaccine intodction b

two to thee eas.

GIVS Strategy 9: Ensure effective and sustainableintroduction of new vaccines and technologies

• Epand sveiance of diseases that can be pe-

vented b new vaccines, and stengthen aboato

capacit to onito the ipact of these new vaccines

on disease pattens and pogae opeations.

It is citica to deveop standadied infoation

and notication sstes that coect data at the

oca eve and epot to highe eves. Qait

indicatos fo the sveiance and onitoingsstes, oganied b distict, hep eep the

focs on stengthening nationa and distict ss-

tes and enabe ea-tie onitoing. EPI has

been etee sccessf in deveoping sch

sstes; othe pogaes cod benet fo

EPI’s epeience b biding on its patfos fo

data coection and feedbac (sch as betins

at sevea eves). Othe pogaes – aaia

and chid sviva in patica – shod conside

coaboating with EPI to institte an annainfoation echanis siia to the EPI Joint

repoting Fo.

monitoing iniation safet is an essentia

coponent of pogae onitoing, both to

assess and ense safet of vaccine deive and

to ense the qait and safet of the vaccines

sed. Iniation safet can be pat ad-




case that eets the standadied case deni-

tion. Neonata tetans sveiance needs to

be stengthened; it eqies stong conitsppot that incdes the abiit to detect and

epot neonata otait in the conit at

heath-faciit eve.

Goba vioogica VPD aboato netwos, with

appopiate capacit at the goba, egiona, na-

tiona and sb-nationa eves, cent povide

ccia sppot to goba poio eadication fo

egiona eiination and acceeated conto

of eases and bea, and fo eow feveconto (in the Afican region). The poven tac

ecod of the goba poio and eases/bea

aboato netwos pesents oppotnities fo

contined epansion – fo eape, biding

appopiate sveiance capacit to sppot

the wide se of eisting vaccines (Hib) and the

anticipated intodction of new vaccines sch as

denge, han papioavis, JE, pneococ-

ca and eningococca conjgate vaccines and

otavis. Specic ephasis shod be pacedon the epansion of goba bacteioogica abo-

ato capacit, especia in ight of the svei-

ance needs of diseases pevented b newe

and soon-to-be-intodced bacteia vaccines

sch as Hib, pneococcs and eningococ-

ca vaccines, and the need to dene the oe

and potentia of othe vaccines sch as tphoid

vaccine in disease-endeic conties. This wi

aso ense that the seotpe coposition of the

vaccines sed – pneococcs, fo eape – isbest sited to cont sitations.

In deveoping conties, pio to the intodc-

tion and se of Hib vaccine in the ea 2000s,

sveiance of invasive bacteia diseases was

iited. De to the ac of disease-bden info-

ation fo Hib sveiance and difcties in

otine diagnosing the disease, an con-

effots to contine to bing thei own esoces

to the joint VPD sveiance netwo at cont

eve. Poio sveiance activities wi eqiecontined etena fnding ding this peiod.

In an conties, patica the east deve-

oped and ow-incoe conties whee disease

sveiance sstes ae not f deveoped,

AFP sveiance sstes have aead been

boadened (e.g. IDS in Afica) to incde the

epoting of othe VPDs, incding eases,

neonata tetans and eow feve. Case-based

sveiance sing aboato conation of

sspected cases is cent avaiabe gobafo poio and, to a esse degee, fo eases

and bea (aboato conation is not e-

qied fo neonata tetans). In an conties,

the oe intensive eases sveiance has

ncoveed bacgond tansission of bea,

as both eases and bea t the sae case

denition of feve and ash iness; an abo-

atoies aso test eases Igm negative sapes

fo bea. In conties whee no bea vac-

cination is offeed, the nbe of bea casesfond incidenta in the cose of eases

sveiance often eads to inceased inteest in

bea conto. Goba eases obidit data is

not nifo we epoted; the conties ost

affected ae epot on eases otait. An

estiation pocess is theefoe sed to dete-

ine the edction in otait. An ipotant

caveat to note is that two factos – the inconsist-

ent qait of avaiabe data and the estiation

pocess – ipte eves of ncetaint to anestiates. These agins of ncetaint shod

be caef eased and epoted.

Siia to eases, eow feve sveiance

eists in an endeic conties and eqies

cinica investigation and epoting of each

case, as we as coection of a se sape

fo eow feve Igm testing fo eve sspect




feed patients fo acoss the cont; it was,

howeve, sef in identifing disease tends in

hospita/efeed patients.

Fo the sveiance of AEFIs, WHO has deve-

oped geneic gideines that can be adapted

to oca esoces and sstes. repoting is

sa case-based. Howeve, in an settings

esoces a on peit case-based epot-

ing fo pe-dened seios events (i.e. events

that ae potentia fata o est in hospitaia-

tion, peanent disabiit o death) o cstes

of events, whie coon and ino events aon be epoted in an aggegate foat fo

the peiphea eve to the sb-nationa and

nationa eves. Active sveiance, based on

a seach fo seected edica events o active

foow-p of vaccines, is patica sef fo

specied events and shot dation (e.g. ding

a ass iniation capaign o fo a iited

peiod foowing intodction of a new vaccine o

epansion of an eisting vaccine to a new taget

popation). In a cases, sveiance a eithebe contwide o iited to sentine epoting

ties did not ecognie the ipotance of Hib

as a case of chidhood otait and disabiit.

As deveoping conties intodced Hib vaccineinto thei pogaes, the need fo ongoing

sveiance was ecognied. In sevea egions,

sentine sites wee estabished to docent

the ipact of the vaccination pogae b

onitoing tends in disease occence. In the

Afican region sppot fo paediatic bacteia

eningitis sveiance (PBmS) was povided

to one aboato pe cont — sa to the

aboato associated with the ain teaching o

nationa efeence hospita. Ceebospina id(CSF) sapes wee investigated fo pathogens,

specica Hib, S. pneumoniae and N. men-

inigitidis. This poved hepf in ost conties

whee data ecoded the oca pesence of these

pathogens; it aowed fo estiation of the

disease bden sing sipe apid assessent

toos and docented vaccine ipact b show-

ing the decine of Hib eningitis cases against

the stead ise in case conts of Steptococcus

pneumoniae eningitis. This sveiance wasnot popation-based and incded on e-

70

60

50

40

30

20

10

0

1997 1998 1999 2000 2001 2002 2003 2004 2005

I n c i d e n c e

( p e r

1 0 0

0 0 0 p

e r

y e a r

)

Seie seie: Deie f hi meigiis med Streptococcus pneumoniae

meigiis fwig idi f hi jge ies, ide ‹5 es, Mwi – 1997-2005

Hi Bante Cit

Hi Bante a

Sp Baante Cit

Sp Bante a

Source: Coege of medicine &

Wecoe Tst laboato at

the Qeen Eiabeth Centa

Hospita, AmP, mOH/PBm

netwo sentine site: Bante maawi




• Estabish a onth goba feedbac betin

fo onitoing pogess towads the achieve-

ent of goba disease conto, sveianceand coveage goas.

• Deveop gideines fo dening e indica-

tos fo a VPD sveiance assessent

and onitoing in ode to onito and

evaate the sstes theseves.

02 | D i s e s e - s e i f i s e i -

e

p i • reach and aintain a eve of AFP svei-

ance that is adeqate to intept wid

poiovis tansission in a mebe States.

• Thogh advocac with mebe States and

dono agencies, aintain cent eves of AFP

and poio ed sveiance staff as we as

ogistics, aboato and sppotive staff ding

the eadication and post-eadication phases.

M e s e s , e , e e s d c r S

• Ai to estabish and aintain a contwide,

active, case-based, aboato-sppoted

ash and feve sveiance sste to deive

data to the set standads in a mebe States.

• Initiate otait sveiance, whee

possibe, to diect ease eases and

neonata tetans otait.

• Estabish and aintain CrS sveiance to

the set standads in egions whee asitaneos bea eiination goa eists.

03 | l e w

• With the sppot of patnes, estabish

and aintain egiona and goba aboato

netwos to sppot the sveiance

sites o geogaphica egions; the atte a be

consideed in the ea phases of estabishing the

sveiance sste.

a I M S

01 | G e e s e i e

• Goba estabish gidance on sveiance

standads fo a VPDs (sing cent and new

vaccines), incding standadied case de-

nitions, case ascetainent and epoting,data anageent, and anasis and standad

sveiance pefoance indicatos. Each

cont to caef adapt the standads to eet

nationa needs in accodance with its disease-

conto pioities, objectives and stategies.

• Deveop genea gideines and standads fo

sing atheatica odeing fo disease

bden and otait estiation; incde cea

instctions on how to ease and epot on

ncetaint in sch estiates. Ense that

these gideines ae pee-eviewed.

• Podce and anna pdate disease bdenestiates fo VPDs; onito pogess towads

the GIVS goa of two-thids edction in goba

chidhood obidit and otait de to VPDs

b ea 2015, copaed to 2000.

• mae copatibe basic disease bden estia-

tion toos avaiabe to conties to assist the in

taing decisions on intodcing new vaccine/s

o changes in thei vaccination pogaes.

WHO-ecoended standads fosveiance of seected vaccine-peventabe diseases




and spevision, data anageent and

epoting.

• Stengthen aboato data anageent and

estabish echaniss fo conication

and coodination to faciitate echange of

infoation: a) between sites, and b)between sites and oca decision-aes.

• Povide goba and egiona capacit to

deveop and coodinate the new aboato

netwos.

04 | new ie d seie seie

• Stengthen WHO headqates and egiona

aboato and sveiance capacit (sis,

han esoces and eqipent) to sppotsveiance of diseases pevented b newe

vaccines, in ode to coodinate the svei-

ance activities at the goba and egiona

eves and povide technica assistance to

conties.

• Estabish sentine sveiance sstes,

sing standadied ethodoogies to

doc ent the baseine disease bden and

netwos, in ode to: a) estabish disease

bden, and b) onito the ipact of into-

dction of new vaccines o vaccination

stategies, incding changes in seotpe

and/o genotpe o oeca epideioog,

and disease epideioog of tagetedpathogens.

• Estabish goba and egiona bacteioogica

efeence aboatoies to sppot and asse

the qait of nationa aboato netwos,

evaate cent avaiabe assas and, whee

appopiate, intodce and evaate new abo-

ato technoogies sch as poease chain

eaction (PCr) and ed-based apid assas.

• Estabish disease-specic goba aboato

standads fo qait assance, pocienctesting, acceditation and standad opeating

pocedes to ense accac and

vaidation of aboato infoation; incde

new VPDs.

• Whee feasibe, in egiona/goba inte-

gated new vaccine aboato netwos to

the egiona/goba poio and eases/bea

netwos, patica fo aboato sppot

NT 23%

P[8]G1

34%

P[8]G3

5%P[8]G4

6%

P[8]G9

4%

P[4]G2

22%

Unusual

6%

pie swig is f ris gees ii i li amei ewee 1996

d 2005. Me seie f is gees is ii f miig e im f

is ie idi i e egi.

laid et a. 2006; Casteo et a., 2004;

ubina et a., 2004; Paa et a., 2005;

mascaenhas et a., 2006; Vootäo et a., 2006;

conties data, 2005-2006.



G F I M S 39

S g i a BI m m u n i z i o n p o g m m m o n i o i n g



GFIMSstrategicareaB | 40

c o n t E x t a n D

b a c k G r o u n D

In iniation pogae onitoing, data

on the pocess and otcoe of the inteven-

tion itsef is coected and anased to povide

vaabe qantitative and qaitative infoation

on pogae pefoance. In ost conties,

onitoing of the ovea heath sste incdes

iniation pogae onitoing, often

as pat of a age copiation of data fo the

sevice deive eve. These data genea in-

cde the deogaphics of peope attending theheath faciities, the sevices offeed to the,

the pocedes foowed and the edicines/vac-

cines povided. In soe conties, othe

chid-heath inteventions ae ecoded si-

taneos with the vaccination taies; this

povides vaabe infoation. The onitoing

data ae genea copied and tansitted

to highe eves once a wee o once a onth.

In addition, anna sa epots povide

feedbac on the avaiabiit, capacit, tainingand stats of staff, and incde anna sa

ges of disease occences, pocedes and

visits. Within an iniation pogae, the

ve coponents genea otined in the

panning pocess ae sevice deive,

sveiance, vaccine anageent and ogis-

tics, advocac and conication and, na,

pogae anageent. monitoing of each of

these coponents povides the anage

with the boad pogaatic infoationhe/she eqies. The conestone of pogae

onitoing – easing vaccination cove-

age and dopot eves – fas within the

sevice-deive coponent. The aea of vaccine

anageent and ogistics onitoing is eceiv-

ing inceasing attention and is descibed beow.

In the oe difct aeas to onito –

pogae anageent pefoance, advocac

and conication – po and heath-sste

indicatos ae genea sed; these incde

stafng eves, bdget ows and the qantit ofconication ateia podced. These aeas

ae, howeve, being inceasing onitoed b

sing pogae anageent indicatos (sch

as tieiness of disbseent of fnds to dis-

tict and sevice deive eves o the popotion

of disticts that have hed a qate spevi-

so eeting ding the past ea), advocac

and conications indicatos (sch as the

eistence of iniation conication pans

at each eve o the pesence of conitvontees/obiies ding iniation ses-

sions), and spevision indicatos (sch as the

popotion of disticts with a spevision pan o

the popotion of panned speviso visits

that have acta been condcted).

GIVS Strategy 6: Improve and strengthen vaccine-

management systems

• Bid capacit fo effective vaccine anageent

thogh taining, spevision and the deveopentof infoation sstes in ode to ense the sa-

fet and potenc of vaccines p to the point of se.

• Condct accate deand foecasting at nationa

and distict eves to ense the nintepted

spp of assed qait vaccines, ato-disabe

singes and safet boes, and new tpes of

eqipent as the becoe avaiabe. Foecasting

shod be eviewed ega to espond to

changing deive stategies.

GIVS Strategy 18: Strengthen the management,analysis, interpretation, use and exchange of data at

all levels

• Contibte to the deveopent of bette toos (e.g.

copte softwae) fo onitoing coveage of

vaccines and ined inteventions, vaccine and

ogistics anageent, and disease sveiance,

to bette sppot data ent, anasis, feedbac,

and tiiation fo pogae anageent.




r o u t I n E c o v E r a G E

rotine vaccination coveage ates ae gen-

ea sed to descibe the popotion of the

tageted popation that has been vaccinated.This infoation is vaabe at eve eve of the

pogae; it povides a ogh estiate of the

popotion of the popation that eains ss-

ceptibe to the disease tageted b the vaccine.

Fthe anasis of coveage data aows the

pogae to deveop pans fo eaching those

who have been issed o who have initiated, bt

not copeted, a vaccination seies (i.e. dop-

ots). It is not on geogaphica baies, btaso socia, econoic, cta and ethnic

baies and sevice deive gaps that can

pevent vaccination. In panning han and oth-

e esoces within the pogae, coveage

shod be consideed as a po fo staff wo-

oad. At the heath faciit eve, coveage data

a be a powef otivato to heath woes

and a vaabe too in feedbac to conities.

At distict eve, coveage can be sed to taget

oteach and ed faciit iniation

sessions; iniation coveage assessents

can identif pogae weanesses that

need to be addessed.

monitoing vaccination coveage is a citica

coponent of onitoing pogae pefo-

ance. It shod be a e fnction of sveiance

staff, togethe with ipoving the qait and

se of data at peiphea eves and sneg with

othe pogae onitoing. In sing sevice

statistics to estiate coveage, it is essentia

to have eiabe and consistent estiates of the

catchent popations, based on popation-censs pojections.

Coveage estiates based on sevice statistics

shod be peiodica vaidated sing ests

fo popation-based sves, sch as a

deogaphic heath sve (DHS) o the uNICEF

tipe indicato cste sve (mICS) that

shod be condcted eve thee eas.

Examle of an immunizaion monioring char

C. Tot. = Cative tota Soce: WHO




A citica coponent of vaccination pogaes

is the nintepted ow of assed qait

vaccines whose potenc is aintained p to thepoint of deive. An inteption to this ow

of vaccines can est in chiden being tned

awa fo a vaccination site withot having

been vaccinated. To ense that this does not

happen, an effective onitoing sste st

be in pace. monitoing of vaccine anage-

ent incdes the onitoing of: a) centa and

egiona vaccine stoes, b) vaccine aivas and

shipents, c) vaccine distibtion and se, d)

vaccine wastage, and e) tepeates in thecod chain.

Given the epense of estabishing and ain-

taining a nbe of disease-specic o po-

gae-specic pesonne in a pats of a

disticts, it is ogica to coaboate with othe

pbic heath pogaes to poote coon

onitoing echaniss. Fo eape, aaia,

HIV, TB, Integated manageent of Chidhood

Iness (ImCI), and EPI pogaes cod wotogethe to joint sppot pogae and

infoation aspects eated to oteach sev-

ices and the rED stateg. lining pogae

onitoing fo joint inteventions is one of the

giding pincipes fo achieving effective disease

sveiance and pogae onitoing. This

topic has been addessed above (see Guiding

pinciple 4).

Pogae eviews ae condcted at eg-a intevas to estabish a sitationa anasis

of pogae coponents. reviews povide

(ost) qaitative infoation that aows fo

e-oientation and enewa of the coponents.

reviews a focs on a specic coponent of

an iniation pogae (e.g. AFP s-

veiance) bt ae oe feqent designed to

assess vaios pogae coponents si-

taneos. A pogae eview is coon

accopanied b a pe-eview sve (sch as a

coveage sve) to add a qantitative copo-nent, o a des eview of eseach papes, tave

epots, constant epots and/o an associated

assessent, sch as a cod-chain invento,

eated to the iniation pogae.

GIVS Strategy 7: Evaluate and strengthen national

immunization programmes

• Condct ega iniation pogae

evaations at oca, distict and nationa eves

and povide feedbac on pefoance, obstacesand new oppotnities to a patnes

The genea ppose of a pogae eview is

to assess the eve of pefoance and identif

constaints and bottenecs enconteed in the

povision of iniation sevices in a cont.

A eview identies aeas with eepa pac-

tices in iniation and eated sevices.

This aows othe aeas to ean and benetfo sch pactices. recoendations can

aso be ade, on the basis of a eview, to

enhance fte pefoance of iniation

sevices in the sstainabe conto of VPDs and

ense ai ipact on chid sviva.

In addition, an EPI eview is a vaabe too in

inceasing the visibiit of a pogae – both

within the cont and etena. As sch, the

advocac oppotnit pesented b an EPI eviewshod not be ndeestiated; it shod be

incded in the panning and ipeentation of

the eview. Siia, fthe advocac shod

be panned aond the foow-p visits that a

be condcted soe tie afte the eview to

deteine whethe o not its ecoendations

have been ipeented.




S t a t u S

In an effot to stengthen coaboation and in-iie the epoting bden, WHO and uNICEF

joint estabished a standad qestionnaie that

has been sed since 1998 to coect infoation

on an anna basis fo mebe States. The

deveopent of this qestionnaie – the Joint

repoting Fo (JrF) – was based on a pocess

of consenss between staff fo uNICEF, WHO

and seected inisties of heath. The tends

of nationa iniation coveage ae a e

coponent of the JrF and, ove the past veeas, have estabished a vaabe tie-seies

of nationa coveage. Initia sevea conties

did not copete the JrF and this cased gaps

in the sste. In the past two eas, howeve,

99 % of the mebe States have copeted it.

Inceasing these data ae foing the basis on

which to jdge a cont’s pefoance. In soe

cases donos sch as GAVI e on these ges

to dive thei pefoance-based sppot.

On the goba eve, coveage onitoing b

vaccine shod contine to be incded in the

anna WHO/uNICEF JrF to aintain ofcia

cont-epoting cces. The feqenc, how-

eve, shod be inceased to a qate cce,

stating with the high-pioit conties and

focsing on the ipoveent of data qait. At

distict, sb-nationa and nationa eves,

coveage onitoing shod be condcted at

east onth; this wod aow fo apiddetection and esotion of pobes in the

deive o qait of the pogae.

Conties that ae eigibe to eceive sppot

fo the GAVI Fnd 11 se JrF coveage data in

sbitting thei appications fo sppot and,aso, sbseqent in thei anna pogess

eviews. In an attept to standadie cont

vaccination data povided fo diffeent soces,

WHO and uNICEF have foed a gop to

evaate avaiabe data; on the basis of these

data, the gop eaches ageeent on a « best »

estiate of coveage.

This pocess oigina incded data points that

vaied hge within soe conties o, withotappaent eason, had wide vaiations fo ea

to ea. Ove the past fo eas, howeve, since

the ceation of this gop, the data epoted

thogh uNICEF and WHO have becoe ch

oe consistent, both ea-b-ea and fo

diffeent soces in the sae ea.

GIVS Strategy 16: Strengthen monitoring of cover-

age and case-based surveillance

• Ipove coveage onitoing of vaccines andothe ined heath inteventions and the se

of infoation at distict and oca eves thogh

stengthening han esoce capacit,

onitoing the qait of data, ipoved toos fo

data copiation, feedbac and spevision.

11 See http://www.gaviaiance.og/Sppot_to_Cont/Who_can_App/inde.php




The ethods that WHO and uNICEF se in e-

viewing nationa estiates of coveage fo inc-

sion in the anna « WHO/uNICEF estiates ofcoveage » ae avaiabe in the pbic doain 12,

togethe with an adit tai of how the estiates

wee deived fo each cont. Pio to ofcia

pbication, each cont eceives its estiates

fo coent/eaction and has the oppotnit to

std its data in an anna cont-constation

pocess. This pocess and its ests ae e-

viewed and appoved b an independent epet

pane.

In addition to otine coveage data, the JrF co-

ects data on:

• anna incidence of seected VPDs,

• nationa ecoended iniation

schedes,

• soces of vaccines,

• iniation coveage,

• iniation-sste indicatos,

• sppeenta iniation activities.

In ode to each the goba vaccination

goas, it is citica – fo a goba and a

patneship pespective – to incease

coveage in sevea conties with age

popations and optiie the contibtion of

iniation to mDG 4. Thee is geat inte-

est in onitoing pogess oe feqent and

thoogh in these conties and the ae

being encoaged to estabish o aintain

epoting sstes that ae abe to povide datato thei nationa heath athoities and inte-

ested paties goba.

With the intodction of stoc anageent and

tepeate ecoding sstes, vaccine an-

ageent onitoing has been estabishedat heath faciit eves. Feqent, howeve,

this infoation is neithe anased no tans-

itted to the net eve to obtain a coective

view of vaccine stoc eves (incding stoc-

ots) and wastage. With the intodction of oe

epensive vaccines, pogae efcienc and

edced vaccine wastage have becoe even

oe ipotant and additiona ephasis has

been paced on these sstes. Copte ss-

tes ae inceasing being paced at povinciaand nationa eves to aintain dg and vaccine

infoation sstes and aow fo oe caef

anageent of deive and odeing.

The vaccine aiva epot onitos intenationa shipentsof vaccines to ense that shipping gideines aefoowed and that vaccine qait is aintained b encoag-ing inceased owneship of the poceent pocess ba the paties invoved.Cedit: WHO/u. katog

12 See http://www.who.int/vaccines-docents/GobaSa/GobaSa.pdf




Iniation visits ae oe coon being

seen as « heath chid » contacts and sevea

additiona inteventions and peventive eas-es ae being ipeented at the sae tie.

Siia, oteach pogaes no onge

povide a singe intevention – iniation

on – bt incde additiona sevices to the

chiden attending. monitoing sstes inceas-

ing capte data on joint pogae inteven-

tions in a nied ecoding sste. Fo eape,

a ta sheet fo vaccine doses adinisteed a

aso povide space to ecod the povision of a

dose of vitain A o epies to qestions sch aswhethe o not the chid sept nde a osqito

net the pevios night.

One of the pposes of joint onitoing ti-

pe heath inteventions is to deteine if these

inteventions sppot each othe and wo insneg. Whie eging inteventions can be

epected to ipove efcienc, it is ipotant to

foow the qait indicatos of the sveiance/

onitoing sste in tacing the « vae fo

one » and effectiveness of integating initia-

tives. Pogae eviews ae cent con-

dcted in the anticipation of evising o ceating

a ti-ea pan o in the face of a specic

pogae pobe. Soeties a detaied

des eview of the stats of iniationwi sfce as a sitationa anasis pio to

a panning cce. most deveoping-cont i-

Global Immunizaion 1980-2006, Dtp3 coverage

Goba Easten mediteanean Westen Pacic Afican

Eopean Aeican Soth East Asian

Soce: WHO/uNICEF estiates, 2006. 193 WHO mebe States. Data as of Feba 2007.




niation pogaes condct a

copehensive pogae eview

ega — appoiate eve ve eas.

a I M S

01 | c e g e m i i g

• rega – at east once a onth – a

conties to onito coveage and vaccina-

tion indicatos (e.g. dop-ot ates) at

nationa and oca eves to onitopogae pefoance and diect co-

ective action as necessa.

• Stengthen the se of data thogh ega

taining and sppotive spevision to

ense that heath staff have the abiit to

onito and intepet basic tends at eve

eve whee data ae coected, coated

o anased.

• Conties to aintain standadied toos

(e.g. ta sheets and egistes) to ecodand tansit pogaatic data, data

ites and epoting feqencies in each

cont; pt sstes in pace to tansit

data fo one eve to the net.

• Conties to epot anna on the

pogess ade in thei iniation

pogaes — sing the WHO/uNICEF

JrF – based on the adinistative

coection of data and an coveage

sves condcted.• As an intega pat of the JrF incde

onitoing the qait of data, based on

an ageed set of indicatos. Whee possibe,

data epoted in the JrF shod be the

« god-standad » of coveage epoting and

shod fo the basis of a onitoing of

vaccination pogaes eqied b

patnes and fndes. In conties

whee diffeences between epoted and

estiated data eist, pt activities in pace

to ense thei convegence.• review the data ites of the WHO/uNICEF

JrF eve two eas with a view to:

a) steaining the in egad to the data

needs at a eves, and b) iniiing the

bden on the conties.

• Peiodica condct a high qait,

nationa epesentative hosehod sve

to povide estiates of coveage. Vaidate

estiates based on sevice statistics

against the coveage estiates.

02 | vie mgeme

• Within the eisting cascading sste of

epoting fo sevice deive eve to

nationa eve, conties shod institte a

sste fo onitoing stoc – at east at

nationa and povincia/sb-nationa stoes.

This shod aow fo the onth epot-

ing of stoc eves and stoc-ots ofvaccines, singes and safet boes,

egation of vaccine distibtion

and peiphea wastage onitoing.

• The nationa vaccine stoe anage shod

copete vaccine aiva fos and send

the bac to the shipping agent. These

data shod be nationa coated and

epoted to the nationa EPI anage and

the inteagenc coodinating coittees

(ICCs). Whee feasibe, ipeent aonitoing sste thogh the nationa

egato athoit (NrA) echanis

to deteine the qait of vaccines

on aiva in the cont.

• Condct effective vaccine stoe anage-

ent assessents at east eve ve

eas o when a ajo change in the

pogae is being panned (sch as the



intodction of a new vaccine).

• maintain an invento of the cod-chain

eqipent sed in the iniationpogae, otining tpe and age

of eqipent, opeating tepeates,

powe soce and stoage capacit.

03 | Ji ieeis

• monito pbic heath inteventions that ae

joint panned and ipeented;

se indicatos that ease: a) each

coponent sepaate, and b) the snegof thei joint ipeentation.

04 | pgmme eiews

• To be effective, design and ipeent

pogae eviews intena, within

a cont; on se etena sppot

(incding constants) to sppot a pocess

owned and anaged b the cont.• Condct eviews of specic coponents

of the iniation pogae

(e.g. a cod-chain eview) eithe when

specic qestions need to be addessed

o specic aeas of need have been

identied. Howeve, whee possibe,

ae a copehensive assessent of the

pogae, taing into consideation

the intepa between a its coponents

athe than ooing at each coponent inisoation.

• Based on EPI eviews, povide eco-

endations that ae specic and actionabe

and pt in pace an ageed pocess to foow

p on thei ipeentation. Idea,

incopoate the ecoendations within

the cmyP pdates.

strategicareaB | 47

rega pogae eviews ae ipotant fo onitoingthe eve of pefoance and identifing constaints and

bottenecs enconteed in the povision of iniationsevices at cont eveCedit: WHO/r. Egges



F u n d i n g 48

d i s s s u v i l l n

n d p o g m m

m o n i o i n g



Fundingdiseasesurveillanceandprogrammemonitoring | 49

To achieve the VPD conto objectives it is citi-

ca to ense fnding fo disease sveiance.

moeove, investing in disease sveianceaes the pbic heath sste oe effec-

tive and efcient – sveiance can, fo ea-

pe, ead to detection of a oca epideic ea

enogh fo conto to be both oe effective

and ess cost in tes of doas epended

and ives caied. Apat fo the heath secto,

epideics can be cost becase of thei ipact

on sevea aspects of the econo, patica

podctivit and intenationa tade and tois.

To contain a disease, bodes – inta-nationao intenationa – ae ineffective. Investent in

sveiance and pbic heath is, theefoe, a

wise ove – not on fo the cont in which

the epideic a be occing, bt aso fo the

conties to which it ight spead. Beond its

oe in contoing devastating epideics, s-

veiance is ipotant in contoing and pevent-

ing endeic diseases that edce podctivit

and can be cost to anage.

Effective pogae onitoing can ae the

pbic heath sste oe efcient and est

in cost savings. monitoing vaccine wastage, fo

eape, can identif pobe aeas and edce

wastage. Aocating esoces fo pogae

onitoing enses efcient se of the avaiabe

esoces and eads to signicant cost sav-

ings eithe fo the conties o fo the donos

that pchase thei vaccines. Tie and ei-

abe coveage onitoing can identif aeaso popations that ae high ssceptibe to

diseases sch as eases. The occence of an

otbea and potentia spead of sch diseases

can ths be pevented b vaccinating those

identied. It shod be noted that the popotion

of esoces needed to ense adeqate svei-

ance and pogae onitoing is inia in

copaison to pogae costs. In the poio

pogae, fo eape, the tota opeationa

cost of its goba aboato netwo (incding

the 75 % coveed b nationa esoces) is ap-poiate 2 % of its etena costs.

Fnding fo VPD sveiance is decining and

thee is no coodinated stateg to obiie

esoces fo sveiance of the cassic and

new VPDs. Cent fnding is genea disease

specic – each VPD has a sepaate channe of

etena and specied sveiance fnding. This

can ceate ibaances; it neithe povides fo

oe nspecied fnding to gaps at the ocaeve no does it stengthen the coss-ctting

fnctions of VPD sveiance. Thee ae iited

esoces that aow fo fnding of coss-ctting

and sppot fnctions of VPD sveiance.

Possibe esoces fo GAVI ae, at pesent,

iited to the conties eigibe fo GAVI sppot;

this often eaves need idde-incoe conties

withot etena sppot.

a I M S

Fdig f disese seie d -

gmme miig

• Estabish advocac and patneing netwos

with dono agencies to aise fnds fo

sveiance and onitoing.

• Estabish atenative and sstainabe

fnding soces (etena fnding in soeconties) with iniation patnes

and fndes to bid on AFP sveiance to

ense that, b 2010, fnds fo non-poio

soces cove at east 50 % of the VPD s-

veiance sste costs coing thogh WHO.

• Ense that conties not on incde

fnding fo the eevant activities in thei



nationa ti-ea pans of action bt

aso specif fnding fo a citica activities,

incding the estabishent and/oaintenance of adeqate bacteioogica

aboato faciities.

• Co-nance povincia spevision and rED

with othe pogaes (sch as aaia,

chid sviva o HIV) that have a need to

ipeent rED-tpe pbic heath

sb-sstes (oteach, spevision, distict

panning, data fo action, contact with

the conit) to achieve high coveage in

a disticts.

Fundingdiseasesurveillanceandprogrammemonitoring | 50



t h w y 51

f o w d



Thewayforward | 52

The GFImS, as descibed in this docent,

was pepaed in constation with inia-

tion patnes and endosed b the StategicAdviso Gop of Epets (SAGE) in Nove-

be 2006. Sbseqent to pbication, it wi be

wide distibted and pocedes fo fthe

discssion wi be initiated. Copies wi be sent

to WHO cont ofces and inisties of heath

to asse its avaiabiit at the nationa eve, as

we as to inteested paties aong goba and

egiona patnes.

An ipotant and gent net step is to deveopa bdget to cove han and nancia esoce

needs to ipeent the goas and objectives

of the goba faewo, at the cont, e-

giona and goba eves. Discssion of the goba

faewo shod be incded in EPI eeting

agendas, patica at egiona and inte-

cont eves, as we as at eetings of EPI

anages and egiona woing gops.

To conve the genc of its essage, this doc-ent encopasses a iited tie-fae. The

ais and activities otined, howeve, shod not

be siia conned bt athe ipeented

and aintained beond these tie iits.

G F I M S a t c o u n t r y l E v E l

It is epected that this GFImS docent wi

povide conties with encoageent andgidance in pdating thei cmyPs to incde

e sveiance and onitoing coponents in

thei stategic panning. The cmyP pocess is an

oppotnit to cost the necessa coponents

of the sveiance and onitoing sste. In

conties whee fnctioning sveiance and

onitoing sstes ae aead in pace, this

docent ais to encoage aintenance and

epansion of these sstes and, whee pos-

sibe, incease integation with othe disease

sveiance and disease-conto pogaeonitoing. In the case of new vaccines o new

onitoing sstes (e.g. vaccine anageent

onitoing), the steps otined wi povide

fthe diection to the initiation of appopiate

sste deveopents.

In nationa ICC discssions this docent

shod seve as a efeence gide to investent

in sveiance and onitoing b in-cont i-

niation patnes and, ain, b the inistof heath itsef. In panning fo additiona GAVI

sppot to conties, especia in tes of

the ecent appoved heath sstes sppot,

conties and ICCs ae encoaged to incde

additiona esoces fo sveiance and i-

niation pogae onitoing in thei

poposas. These esoces shod be sfcient

to ense that high qait data ae avaiabe to

decision-aes fo ests-oiented ease-

ents of iniation pogae ipact,in tes of both iniation coveage and

edced disease bden.

The se of data at distict and sevice-deiv-

e eves, whee diect action can be taen to

ectif an pogaatic o epoting pobes,

is the tiate objective of a onitoing and

sveiance. Capacit-biding at these eves,

to obtain, anase and act pon eevant data, is

the fndaenta goa of the goba faewo.In conties that have not et taen the foowing

actions, the specic tass otined beow shod

be consideed to be « net steps » in ipeent-

ing the goba faewo.

• In a joint activit between the iniation

pogae and the epideioog and data

sections, se the GFImS:



Thewayforward | 53

a) to do in-cont assessent of svei-

ance and onitoing of coe capacities,

needs and oppotnities fo integation,as a coponent of the IHr 2005 eqie-

ents;

b) to chec which aeas of pogae

onitoing and VPD sveiance ae

fnctioning we and which ae decient;

c) to decide which new appoaches to oni-

toing and sveiance can be consideed.

• Whee needs ae identied, ascetain the

cost of eeting these needs and tae eve

oppotnit to obiie esoces. FoGAVI-eigibe conties, pogae onito-

ing and sveiance sppot a be

consideed nde the fnding window fo

Heath Sstes Stengthening.

• Estabish a in between the i-

niation pogae, the epideioog o

heath infoation sstes and the

aboato sppot nits at a eves within

the cont. Idea, these teas shod

be in continos contact with each othe;atenative, ega eetings to povide

pdates shod be consideed.

• Ense that iniation pogae

and VPD sveiance data ae

ega eviewed and acted pon within

the EPI tea. This shod be etended to ICC

eetings, oganiationa o agenc staff

eetings and intecont EPI anages’

eetings.

• Institte ega infoation and data evieweetings at sb-nationa and distict

eves, possib in connection with eisting

speviso o taining activities.

G F I M S a t t h E r E G I o n a l

l E v E l

The WHO egiona ofces ae piai e-

sponsibe fo the povision of technica assist-

ance in conties to deveop and aintain the

sveiance and onitoing sstes. In cases

whee egions have taen the ead in deveoping

sveiance sstes (e.g. egiona otavis-

sveiance aboato netwos), thei epei-

ence and now-how shod be ade avaiabe

to othe egions whee those sis and epei-

ences a be acing.

Second, the WHO egiona ofces pa a c-

cia oe in the ega coection and coation

of data fo conties and theeb affect the

ipoveent of data qait and copeteness.

Standadied epoting foats and feqencies,

togethe with egiona data-checing activities,

ae a conestone of accate epoting. Whee

new sstes ae being deveoped, o the inte-

gation of eisting sveiance and onitoingsstes ae being panned, it is essentia that

the egiona focs fo coodination, coation and

snthesis of data and cont sppot is ss-

tained and fthe enhanced.

Fina, the qait assance and acceditation

of nationa aboatoies eain e fnctions of

egiona staff.

G F I M S a t t h E G l o b a l

l E v E l

Fthe to copiing this docent otining the

vision and need fo high qait sveiance and

onitoing sstes, WHO headqates ais

to pdate and/o deveop technica gideines

on each of the aeas of wo descibed. It pans



Thewayforward | 54

to otine the necessa standads and indica-

tos of sveiance and onitoing and assist

in the deveopent of standadied pocedesfo the epoting and anasis of pogae and

sveiance data. Goba standadiation and

coodination wi be needed, patica in the

aea of new estabished sveiance

and onitoing sstes, sch as the bacte-

ioogica aboato sentine sites fo Hib and

pneococca sveiance. WHO wi ense

that eadeship is povided in the estabishent

of these sstes.

using this docent as an advocac too,

goba eve patnes ae caed pon to obiie

esoces fo VPD sveiance and inia-

tion pogae onitoing, incding

the aintenance of eisting, fnctioning

sstes, sch as AFP sveiance fo poio.

This wi aow potentia fnding oganiations to

bette ndestand the copeit and

beadth of the sstes and be abe to contibte

to the vision of the goba faewo.

c o n c l u S I o n

With the SAGE endoseent and wide cont

and patne b-in to the goba faewo, it

is anticipated that a fondation wi be aid pon

which the GFImS vision can be eaied. Having

stated the case fo VPD sveiance and

iniation pogae onitoing, ftheinteactions with othe sveiance and

pogae onitoing sstes can siia

be soght and effective ipeented.



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naes of popieta podcts ae distingished

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A easonabe pecations have been taen

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Pinted b the WHO Docent Podction

Sevices, Geneva, Switeand

Photo cedits :

Cove : WHO/r. ka

P. 07, 13, 51 : WHO

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