Post on 10-Apr-2018
transcript
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 1/56
II
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 2/56
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 : vaccines@who.int
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 3/56
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 4/56
ACkNOWlEDGEmENTS | 05
ABBrEVIATIONS AND ACrONymS | 06
ExECuTIVE SummAry | 07
THE GFImS VISION | 12
INTrODuCTION | 13
GFIMS StrateGIc area a:
SurVEIllANCE OF VACCINE-
PrEVENTABlE DISEASES | 29
GFIMS StrateGIc area B:
ImmuNIzATION PrOGrAmmE
mONITOrING | 39
FuNDING DISEASE SurVEIllANCE
AND PrOGrAmmE mONITOrING | 48
THE WAy FOrWArD | 51
o n n s 04
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 5/56
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 6/56
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 7/56
x u i v 07
s u m m y
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 8/56
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 9/56
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.
executivesummary | 09
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 10/56
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.
executivesummary | 10
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 11/56
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.
executivesummary | 11
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 12/56
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.
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 13/56
i n o d u i o n 13
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 14/56
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.
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 15/56
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.
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 16/56
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 17/56
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 18/56
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 19/56
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.
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 20/56
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 21/56
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 22/56
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 23/56
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 24/56
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 25/56
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 26/56
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 27/56
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 28/56
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 29/56
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 30/56
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.
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 31/56
GFIMSstrategicareaA | 31
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 32/56
GFIMSstrategicareaA | 32
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-
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 33/56
GFIMSstrategicareaA | 33
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 34/56
GFIMSstrategicareaA | 34
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 35/56
GFIMSstrategicareaA | 35
• 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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 36/56
GFIMSstrategicareaA | 36
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.
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 37/56
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 38/56
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 39/56
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 40/56
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.
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 41/56
GFIMSstrategicareaB | 41
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 42/56
GFIMSstrategicareaB | 42
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.
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 43/56
GFIMSstrategicareaB | 43
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 44/56
GFIMSstrategicareaB | 44
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 45/56
GFIMSstrategicareaB | 45
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.
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 46/56
GFIMSstrategicareaB | 46
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 47/56
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 48/56
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 49/56
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 50/56
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 51/56
t h w y 51
f o w d
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 52/56
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:
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 53/56
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
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 54/56
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.
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 55/56
© Wod Heath Oganiation
A ights eseved. Pbications of the Wod
Heath Oganiation can be obtained
fo WHO Pess, Wod Heath Oganiation,20 Avene Appia, 1211 Geneva 27, Switeand
(te: +41 22 791 3264; fa: +41 22 791 4857;
eai: booodes@who.int). reqests fo pe-
ission to epodce o tansate WHO
pbications — whethe fo sae o fo nonco-
ecia distibtion — shod be addessed
to WHO Pess, at the above addess (fa: +41 22
791 4806; eai: peissions@who.int).
The designations epoed and the pesentation
of the ateia in this pbication do not ipthe epession of an opinion whatsoeve on the
pat of the Wod Heath Oganiation concen-
ing the ega stats of an cont, teito, cit
o aea o of its athoities, o concening the
deiitation of its fonties o bondaies. Dot-
ted ines on aps epesent appoiate
bode ines fo which thee a not et be f
ageeent.
The ention of specic copanies o of
cetain anfactes’ podcts does not ipthat the ae endosed o ecoended b
the Wod Heath Oganiation in pefeence
to othes of a siia nate that ae not en-
tioned. Eos and oissions ecepted, the
naes of popieta podcts ae distingished
b initia capita ettes.
A easonabe pecations have been taen
b the Wod Heath Oganiation to veif the
infoation contained in this pbication. How-
eve, the pbished ateia is being distibtedwithot waant of an ind, eithe epessed
o ipied. The esponsibiit fo the intepeta-
tion and se of the ateia ies with the eade.
In no event sha the Wod Heath Oganiation
be iabe fo daages aising fo its se.
Pinted b the WHO Docent Podction
Sevices, Geneva, Switeand
Photo cedits :
Cove : WHO/r. ka
P. 07, 13, 51 : WHO
P. 29, 39, 48 : WHO/r. ka
8/8/2019 Global Framework for Immunization Monitoring and Surveillance-444
http://slidepdf.com/reader/full/global-framework-for-immunization-monitoring-and-surveillance-444 56/56