News In this issue

News

Brazil Launches a Book Celebrating the

40th Anniversary of its National Im-munization Programme

Retirement from WHO service

GAVI seeking independent review committee (IRC) members

2

2

3

Meetings / workshops

Regional Meeting on Sentinel Rotavirus

Surveillance, Bacterial Pneumonia and Meningitis

Intercountry meeting on Measles / Rubella control and elimination

2nd Workshop to Share Lessons Learned in the Development and Imple-

mentation of Electronic Immunization Registries Mid-Level Management workshop

Meeting of the Regional Technical Advi-sory Group on Immunization

Towards expanded Immunization cov-

erage in India: National Training and Programme Review with State Immun-ization Officers

Twenty-ninth Meeting of the Caribbean EPI Managers held at Runaway Bay in

Jamaica

3

4 5

6

7

8

Resources 9

Calendar 10

Links 11

Important Milestone for the pooled vaccine procurement

initiative in the Eastern Mediterranean region Nadia Teleb, WHO Regional Office for the Eastern Mediterranean

A session on Pooled Vaccine Procurement (PVP)

Initiative was held during the technical meetings of

the Sixtieth Session of the WHO Regional Commit-

tee for the Eastern Mediterranean, in Muscat,

Oman, on Sunday 27 October 2013. During the

session, Member States were briefed on the pro-

gress of the PVP initiative by WHO/EMRO and

UNICEF Supply Division. During 2013, important

steps have been taken by WHO, UNICEF and oth-

er partners for responding to Member States’ re-

quests. In June 2013, a technical inter-country

workshop for the establishment of PVP System was

held in Sharm El Sheikh, Egypt. Participants to the

meeting provided comprehensive feedback about

their countries and country specific action plans for

participating in the PVP initiative were developed

(both for Stage 1 though UNICEF and Stage two

through WHO EMRO).

Acknowledging the challenges of middle income countries on sustainability and access to

affordable prices, especially on new and under-utilized vaccines, Member States indicated

their strong commitment on the PVP initiative and adopted Resolution EM/RC60/R1

which urges Member States to take immediate action, if they are interested middle-

income countries, to participate in the pooled vaccine procurement system and to sign a

memorandum of understanding with WHO and UNICEF to complete the participation

process by end 2013, and requests WHO/EMRO Regional Director to confirm with in-

terested Member States their commitment to implementing the proposed pooled vaccine

procurement system.

The PVP System is expected to strengthen immunization programmes by creating a com-

munication, coordination and cooperation platform throughout the region and will be

based on the principles of “Member State Ownership”, “Solidarity, Trust and Support”,

“Sustainability”, “Transparency” and “Mutual Learning”.

Global Immunization News (GIN) November 2013

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Resolution EM/RC60/R1

Brazil Launches a Book Celebrating the 40th Anniversary of its National

Immunization Programme Carla Magda Domingues and Antonia Teixeira, Ministry of Health, Brazil; Samia Samad, Pan American Health

Organization (PAHO-BRA), Brazil and Lucia Oliveira (PAHO-WDC)

On 18 September 2013, the Brazilian Ministry of Health (MOH) celebrated the

40th anniversary of its National Immunization Programme . To commemorate this

anniversary, the Brazilian MOH published 40 Anos: Programa Nacional de

Imunizações (40 Years: National Immunization Programme). Participating in the

celebration was Brazil’s Secretary of Health Surveillance, Jarbas Barbosa, and

National Immunization Programme (NIP) coordinator, Carla Magda Domingues.

The NIP´s initial goal was to provide free vaccines to the entire Brazilian

population at public health centers. Doctors Barbosa and Domingues contributed

introductions to the book indicating the gratitude and appreciation they have for

Brazil’s NIP and the strides it has made in the past forty years. The programme

was described as very successful, incorporating an important variety of public

health intervention components and accepted widely and positively by the

Brazilian population. Among the successes of the Programme, they highlighted its

impact on the elimination or reduction of diseases, such as smallpox, polio,

measles, and rubella. The Brazilian MOH attributes the continuous success of the NIP to the commitment of the

thousands of vaccinators, their dedication and work ethic. Health authorities also attributed the NIP success to a

cooperative government, task forces and activities carried out to promote health and disease prevention. Brazil’s 40 Anos: Programa Nacional de Imunizações

NIP current coordinator Carla Magda Domingues had kind words to say regarding the successful trajectory the

NIP has had since its birth in 1973. It has been recognized both nationally and internationally as a brilliant

execution in the scope of public health, defined by the prioritization of the promotion, prevention, and protection

of the health of the Brazilian population. She looks to the future to keep rebuilding and strengthening the

programme, so countries and regions that have recently started a National Programme on Immunization can find

motivation in the Brazilian experience.

Retirement from WHO service Elsa Derobert and Claudio Politi, WHO HQ and Michael Hinsch and Sarah Schmitt, WHO HQ Consultants

After 40 years of dedicated work in the field of social protection,

development and health economics, Miloud Kaddar will retire at the

end of 2013. Passionate about his field, Miloud has committed much

of his work to health financing and the pharmaceutical sector. His

more recent focus has been on building country capacity in immuniza-

tion financing and health system development, best practices in vac-

cine procurement, pricing policies and transparency of vaccine prices.

His career has taken him many times around the globe, allowing him

to work in numerous countries, both in his functions as Senior Health

Economist and Adviser, and as associate professor and applied re-

searcher at various academic institutions.

Since 2002, Miloud has worked at WHO/IVB, focusing on vaccine financing, planning, procurement and pricing.

His focus has been on access, sustainability and country ownership of immunization programmes, placing a strong

emphasis on GAVI graduating and middle-income countries. Miloud has been active in every WHO region and

has been a welcome and valued contributor from country to global policy and academic level. His team will miss

his incredible enthusiasm, knowledge, honesty and integrity. We wish him every success in his future and hope he

will enjoy his retirement.

Although retiring, Miloud will remain active in the immunization and health system community. From December

2013 onward, he can be reached at this address.

Page 2

Global Immunization News (GIN) November 2013

Miloud Kaddar, retiring from WHO

GAVI seeking independent review committee (IRC) members Rehan Hafiz, GAVI Secretariat

The GAVI secretariat is seeking to replenish the current pool of suitable candidates for Independent Review

Committee (IRC) Members. They are aiming to bring in individuals with expertise in Health System Strengthening

(HSS), Immunization and in new interventions such as inactivated polio vaccine (IPV).

Following development of the required criteria and the areas of expertise for the members, the call has now been

posted on the GAVI website. This is also intended to be an opportunity to increase the pool of French speaking

reviewers and it is hoped will generate applications from individuals from Francophone countries.

The process is being undertaken on behalf of the GAVI Secretariat by Korn Ferry, a company that is among the top

global executive search firms.

Interested candidates can view more information at this link.

Candidates can also send their CV directly to thish mailbox created specifically for GAVI.

Page 3

Global Immunization News (GIN) November 2013

Meetings / workshops

Regional Meeting on Sentinel Rotavirus Surveillance, Bacterial Pneumonia and

Meningitis

Jennifer Sanwogou and Lucia Oliveira, PAHO/WHO

Location: Cancun, Mexico

Date: 9-11 December 2013

Participants: New vaccine surveillance representatives from 23 countries, PAHO and partners.

Purpose: 1) To review the sentinel surveillance situation of rotavirus, bacterial meningitis and pneumonia,

including its achievements and challenges; 2) To follow up on laboratory network performance in

sentinel surveillance, including its results and challenges; and 3) To discuss the results of the strategic

review of new vaccine surveillance and the relevant next steps.

Details: This meeting was a joint activity between PAHO and the SABIN Vaccine Institute. After five years

since the beginning of New Vaccines surveillance in the Region of the Americas, this meeting was a

good review and summary of what has been done in the region regarding surveillance and what will

be the next action steps for the coming years. During the last day of the meeting, the countries were divided into three groups to discuss data

quality, epidemiological and laboratory integration, and the WHO Global New Vaccines Surveillance

Network. The groups later presented better ways to analyze, integrate and report data, and the

activities required to continue being a part of the WHO Global New Vaccines Surveillance Net-

work.

Page 4

Global Immunization News (GIN) November 2013

Intercountry meeting on Measles / Rubella control and elimination

Nadia Teleb, WHO Regional Office for the Eastern Mediterranean

Location: Amman, Jordan

Date: 17-20 November 2013

Participants: National EPI Managers;

National officers for Mea-

sles surveillance; national

officers responsible for

measles laboratory sur-

veillance; partner organi-

zations like: CDC Atlanta,

GAVI Alliance and

UNICEF; Regional Tech-

nical Advisory Group

(RTAG) members; re-

gional validation commit-

tee (RVC) experts; chair-

persons of National Im-

munization Technical Ad-

visory Groups (NITAGs)

Group photo of the participants

Purpose: Review countries’ progress towards achieving the regional measles elimination target; Review and

follow up on the implementation of the different components of the regional strategy for measles

elimination; and review and update the national plans for strengthening measles and rubella elimi-

nation and control programme.

Details: After the review of the global and regional updates towards measles elimination, the meeting high-

lighted the progress in achieving and sustaining high population immunity against measles and ru-

bella. The discussions were on two main themes: (1) Maintaining low measles incidence, high

population immunity, and strong case based surveillance, for which presentations were made by

countries in the elimination process or close to elimination; and (2) Focusing on measles out-

breaks in Syria and other neighboring countries. Group work sessions reviewed the situations of

Member States in measles and rubella elimination in relation to population immunity and the sur-

veillance progress in achieving the targets of measles and rubella surveillance performance indica-

tors. The meeting included a session on enhancing rubella and congenital rubella syndrome (CRS) con-

trol and elimination in the Eastern Mediterranean Region, in which progress, challenges and next

steps were discussed with the Member States. In addition, a session on the Polio Eradication End-

game strategy included discussions on strengthening routine immunization and the introduction of

the Inactivated Polio Vaccine (IPV). National immunization programmes are recommended to have policies and relevant operational

plans to “catch-up” with the children who miss the first dose of the Measles Vaccine (MV) and

ensure that all children receive two doses of MV by the age of two.

Page 5

Global Immunization News (GIN) November 2013

Second Workshop to share lessons learned in the Development and

Implementation of Electronic Immunization Registries (EIRs)

Carla Magda Domingues and Antonia Texeira, Ministry of Health, Brazil; Samia Samad, PAHO Brazil and Carolina

Danovaro, PAHO, Washington DC

Location: Brazilia, Brazil

Date: 18-19 November 2013

Participants: Representatives from 17 countries of the

Americas, including 21 participants from

sub-national levels of Brazil; Albania; Ango-

la; Ghana; Sri Lanka; Tanzania; the Open

Source Medical Informatics initiative

(IMeCA) for Latin America; Training pro-

grammes in epidemiology and uublic health

interventions network (TEPHINET); PA-

HO; and WHO. BMGF, CDC, GAVI,

UNICEF and other WHO regions re-

ceived a Web link to follow the workshop

online.

Workshop participants, Brasilia, 18-19 Nov 2013

Purpose: To share practical experiences regarding the development and implementation of electronic immun-

ization registries (EIRs) in order to promote EIR strengthening; to define lessons learned and best

practices on the development and implementation of electronic immunization registries (EIRs), for

dissemination; to discuss countries’ needs regarding a practical field guide on EIRs; to jointly define

next steps on the EIR work among countries of the Americas and with PAHO/WHO.

Details: Representatives of Brazil’s Ministry of Health (MOH) and PAHO-Brazil welcomed participants to the

meeting, highlighting the importance of having accurate data to monitor increasingly complex immun-

ization programmes. Electronic Immunization Registries (EIRs) were cited as a powerful tool to im-

prove vaccination monitoring in order to increase coverage rates in an equitable manner. PAHO presented an overview of the current situation on the development and implementation of

EIRs in Latin America, along with the most recent recommendation of PAHO’s Technical Advisory

Group (TAG) on vaccine-preventable diseases, and the objectives of the workshop. The host coun-

try, Brazil, presented its experience implementing their national EIR. The workshop was divided in plenary sessions and work groups. Day one of the workshop focused

on practical issues related to primary data collection (including form design); flow and data entry;

online and offline EIRs; strategies to ensure EIR completeness, unique identifiers, confidentiality and

management of potential duplicate records. The groups also discussed the conditions, and risks, to

consider when proposing an immunization registry and how to monitor the implementation of an EIR

(data quality, denominator completeness, software functioning and acceptability, among others). Dur-

ing day two presentations and discussions focused on interoperability, confidentiality, data security,

EIR relationship with Health Information Systems, and the potential role of mHealth. Groups pro-

posed recommendations on EIR outputs for managers (reports, maps, graphs), making the EIR useful

for the local level (follow-up, recall/reminders), and on how to make EIRs interoperable with other

national information systems. As in the first Latin American workshop on EIRs in 2011, the openness and willingness of the partici-

pant countries to share experiences, products, successes and failures was commendable. PAHO acknowledges the generous contributions of Brazil MOH and the Bill and Melinda Gates Foun-

dation in making this workshop possible. To see the recording of the plenary sessions of this workshop (Video in original language) or Black-

board Recording (English translation): Monday 18 November Full day; Tuesday 19 November Part 1

AM; Part 2 PM; Part 3 PM; Part 4 PM.

Page 6

Global Immunization News (GIN) November 2013

Meeting of the Regional Technical Advisory Group on Immunization

Nadia Teleb, WHO Regional Office for the Eastern Mediterranean

Location: Amman, Jordan

Date: 21 November 2013

Participants: Regional Technical Advisory Group

(RTAG) members; Regional Valida-

tion Committee (RVC) experts;

chairpersons of National Immuniza-

tion Technical Advisory Groups

(NITAGs); partners: CDC Atlanta,

Network for Education and Support

in Immunization (NESI)

Group photo of the participants

Purpose: To review the current situation of measles and rubella in the Region; to review the mandate and

agree on the Terms of Reference of the proposed RVC; to define internal procedures and re-

sponsibilities of the proposed members of the RVC; to revise and endorse the regional guidelines

for measles and rubella (MR) elimination verification and agree on the criteria, parameters, and

procedures for documenting and verifying the achievement of elimination in the countries of the

EMR, in consultation with the RTAG members.

Details: Informative sessions included detailed discussions on: The progress towards measles elimination

in the Eastern Mediterranean Region: RTAG decided that the Measles Elimination target in the

Region should not be further postponed for keeping the momentum and enhancing commitment

of decision makers; Scaling up the use of Rubella vaccine and developing a regional target for Ru-

bella/ Congenital Rubella Syndrome (CSR) elimination: Rubella elimination target for the Region

was recommended to be set as 2020; Establishment of the RVC and development of regional

guidelines for the documentation and verification of MR elimination; the situation of new vaccine

introductions in the Region; Enhancing introduction of the Inactivated Polio Vaccine (IPV) in the

context of Polio End Game strategy; and Strengthening NITAGs and their role in achieving nation-

al EPI targets: Given that nearly all of the Member States in the Region have already established

NITAGs, the regional strategy will focus on strengthening the functions and quality of decision

support processes of NITAGs. NITAGs are encouraged to support EPI programme and decision

makers on above discussed topics, as well as considering collaborating with education institutions

to support human resources needs of the national immunization programmes.

Page 7

Global Immunization News (GIN) November 2013

Towards expanded Immunization coverage in India: National Training and

Programme Review with State Immunization Officers

Balwinder Singh, WHO Country office for India

Location: New Delhi, India

Date: 3-6 December 2013

Participants: Fifty State Immunization Officers

(SIOs) and state-level officers from

partner organizations participated in

the workshop that was supported by

WHO Country Office for India. Ex-

perts from the Ministry of Health and

Family Welfare (MoHFW), WHO,

UNICEF and other stakeholders facili-

tated the workshop. The WHO Rep-

resentative to India and the Additional

Secretary & Mission Director

(National Health Mission), MoHFW,

Government of India were the special

invitees.

Participants of the training with the WHO Representative to India

Purpose: To strengthen the technical and managerial capabilities of the State Immunization Officers of India in

immunization programme management, including effective planning, implementation and monitoring of

the programme in the states.

Details: The overall emphasis was on leveraging the success of polio eradication in India to strengthen routine

immunization (RI). The workshop built on the lessons learnt and was successful in enhancing the ca-

pacity of the SIOs to review and develop coverage improvement plans for routine immunization in

their states. The SIOs were provided technical updates on current topics of interest in the field of immunization

and updated on programmatic priorities in India and individual states. Feedback from the participants

has clearly indicated an improved understanding of all aspects of the programme: microplanning for

routine immunization, strengthening of immunization review mechanisms, conducting training of

frontline workers, monitoring RI programme to identify gaps and take corrective actions, Adverse

Event following Immunization (AEFI) reporting, vaccine-preventable diseases (VPD) surveillance and

development of communication plans. Given the success of this initiative, MoHFW has agreed to extend support to the states for conduct-

ing similar training workshops for their district immunization officers (DIOs) and a training calendar

for this was prepared during the workshop.

Page 8

Global Immunization News (GIN) November 2013

Twenty-ninth Meeting of the Caribbean EPI Managers held at Runaway Bay in

Jamaica

Primnath Ritoe, PAHO/WHO Representation, Kingston, Jamaica

Location: Runaway Bay, St Ann, Jamaica

Date: 18 – 21 November 2013

Participants: Ninety-one participants representing thirty coun-

tries in the Caribbean sub-region, including the

French and Dutch speaking Caribbean, the Carib-

bean Public Health Agency (CARPHA), the United

Kingdom Overseas Territories, the Netherlands,

University of the West Indies (MONA), Ministry

of Health (Jamaica) and PAHO.

The Minister of Health, Jamaica, and participants.

Photo: PWR/JAM/EPI

Purpose: To analyze and share experiences on the Expanded Programme on Immunization (EPI). Special

areas of discussion were the analysis of the status of the EPI in each country; areas requiring

strengthening; the targets, objectives and budget for 2014; information on selective scientific top-

ics of common interest in relation to immunization; status of verification of Measles, Rubella and

Congenital Rubella Syndrome (CRS) elimination in the Americas; discussion of status and advanc-

es made in the surveillance and management of vaccine preventable diseases; and the introduction

of new and underutilized vaccines in the national immunization schedules.

Details: The Governments and peoples of the Caribbean Community are committed to the sustainability

of the immunization program. Completing the activities of verification and documentation of elim-

ination of measles, rubella and CRS in the Caribbean countries was one of the main achievements

of the previous year. The overall vaccination coverage for administered vaccines for 2012 shows

overall improvement compared to the years before.

The year 2012 has been challenging with maintaining current services and implementing activities

regarding the transfer of the EPI office at CAREC to PAHO office, Jamaica as of January 1st, 2013.

One significant milestone in disease surveillance was the installation of the ISIS application – PA-

HO platform for VPD surveillance – in the EPI Unit in PAHO Jamaica and in the Surveillance Unit

of the Ministry of Health of Jamaica.

Prior to the 29th EPI Managers’ Meeting, a one-day training workshop on immunization was held

for the EPI Managers, on November 18. The purpose of the meeting was to present technical

updates, clarify selected issues and discussing the changes within the programme.

The Henry C. Smith Immunization Award was presented this year to Turks and Caicos Islands.

Barbados received the first price for surveillance, while the second and third places went to

Montserrat and Belize, respectively.

Resources

Page 9

Global Immunization News (GIN) November 2013

SAGE Decade of Vaccines (DoV) Global Vaccine Action Plan (GVAP) Assessment

Report 2013

The SAGE Decade of Vaccines (DoV) Global Vaccine Action Plan (GVAP) Assessment

Report 2013” is now available online. This can be accessed from the following web

link: Check out the “Annual Reports” section.

The Global Vaccine Action Plan (GVAP) was endorsed by the World Health Assem-

bly in May 2012 to achieve its “Decade of Vaccines” vision of universal access to im-

munization.

As requested by the Member States, the WHO Strategic Group of Experts (SAGE)

presents, in this report, a review of the progress with the implementation of the

GVAP and makes recommendations to national governments, international organiza-

tions and development partners for actions required to meet the goals and objectives

of the plan.

At the November 2013 meeting. SAGE endorsed the following recommendations as the major areas of necessary

focus: 1. Improving data quality, 2. Increasing immunization coverage, 3. Accelerating progress towards measles and

rubella/CRS elimination, and 4. Enhancing country ownership of national programmes. This should allow the DoV

Working Group to prioritize the specific issues to focus on during the next few years.

For information on the Decade of Vaccines and the Global Vaccine Action Plan please send an email.

Planning an information systems project? PATH/WHO toolkit can help Dan Brigden, WHO Consultant

An online version of the ICT Toolkit developed by project Optimize has been published on the TechNet-21.org web-

site.

The original document, entitled Planning an information systems project: A toolkit

for public health managers, is available as a PDF on the PATH and WHO websites,

and provides guidance to public health managers planning the implementation of in-

formation and communications technology in health information systems. It draws

on lessons learned by project Optimize, a five-year collaboration between the

World Health Organization and PATH, to help optimize the vaccine supply chain.

The ICT toolkit focuses on the planning phase of an information systems project. It

proposes an eight-step process that can help managers:

Choose the solution that best fits their needs and context.

Obtain the external help and expertise they need.

Develop, scale, and then sustain their chosen solution.

The online version of the toolkit provides links to internet content such as documents, websites and YouTube mov-

ies that the PDF was not able to include. It also enables registered TechNet users to comment on and rate individual

pages. Jan Grevendonk, co-author of the ICT Toolkit, explains the benefits of these new features: “We wanted to

take the PDF and turn it into something dynamic and interactive, a place for public health managers to share experi-

ences and learn from each other. Hopefully this will help to stimulate more in-depth discussion within the immuniza-

tion community about ICT project planning.”

Visit the online version of the ICT Toolkit today.

An online version of the ICT

Toolkit has just been released.

Credit: WHO.

Page 10

Calendar January 2014

16-25 WHO Executive Board Geneva, Switzerland

27-28 SEARO GAVI Regional Working Group meeting TBD

February

18-19 Next Generation Vaccine Delivery Technology Meeting Geneva, Switzerland

24-7Mar AFRO IST Expanded Programme on Immunization Managers meeting TBD

March

4-6 Global Vaccine Research and Immunization Research Forum (GVIRF) Bethesda, USA

18-21 WPRO Regional Verification Commission Meeting Seoul, Republic of Korea

April

7-11 Workshop on vaccine safety (AEFI) surveillance and communication capacity building TBD

23-30 World Immunization Week Global

29-30 Global Measles and Rubella Management Meeting Geneva, Switzerland

Global Immunization News (GIN) November 2013

May 2014

15-24 67th World Health Assembly Geneva, Switzerland

20-22 Expert consultation on accelerated control of Japanese encephalitis in the Western Pacif-

ic Region

Manila, Philippines

June

3-5 Third Workshop for NRAs for Vaccines in Western Pacific Manila, Philippines

24-26 AFRO Ministerial Conference Addis Ababa, Ethiopia

TBD WPRO 23rd Expanded Programme on Immunization Technical Advisory Group Meeting Manila, Philippines

Page 11

WHO Regional Websites Routine Immunization and New Vaccines (AFRO)

Immunization (PAHO)

Vaccine-preventable diseases and immunization (EMRO)

Vaccines and immunization (EURO)

Immunization (SEARO)

Immunization (WPRO)

Newsletters Immunization Newsletter (PAHO) The Civil Society Dose (GAVI CSO Constituency) TechNet Digest RotaFlash (PATH) GAVI Programme Bulletin (GAVI)

Organizations and Initiatives American Red Cross Child Survival Agence de Médecine Préventive Africhol EpiVacPlus LOGIVAC Project SIVAC Johns Hopkins International Vaccine Access Center Vaccine Information Management System PneumoACTION JSI Africa Routine Immunization Systems Essentials Project IMMUNIZATIONbasics PAHO ProVac Initiative PATH Vaccine Resource Library Rotavirus Vaccine Access and Delivery Malaria Vaccine Initiative Meningitis Vaccine Project RHO Cervical Cancer Sabin Vaccine Institute Sustainable Immunization Financing

UNICEF Immunization Supplies and Logistics USAID Maternal and Child Health Integrated Program WHO Department of Immunization, Vaccines & Biologicals New and Under-utilized Vaccines Implementation ICO Information Centre on HPV and Cancer Immunization financing Immunization service delivery Immunization surveillance, assessment and monitoring SIGN Alliance Other Coalition Against Typhoid Dengue Vaccine Initiative European Vaccine Initiative Gardasil Access Program GAVI Alliance International Association of Public Health Logisticians International Vaccine Institute Measles & Rubella Initiative Multinational Influenza Seasonal Mortality Study TechNet-21 Vaccines Today

UNICEF Regional Websites Immunization (Central and Eastern Europe)

Immunization (Eastern and Southern Africa)

Immunization (South Asia)

Immunization (West and Central Africa)

Child survival (Middle East and Northern Africa)

Health and nutrition (East Asia and Pacific)

Health and nutrition (Americas)

Links

Global Immunization News (GIN) November 2013