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Analytical summary - Immunization and vaccines development

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TB remains a serious concern in Namibia, which has one of the highest case notification rates in the world. However, the number of TB cases notified has dropped from 16,156 in 2004 to 13,332 cases in 2009 (WHO Namibia, 2010; MoHSS, December 2010). The diseases that are targeted for elimination and eradication include polio, measles, neonatal tetanus and malaria.

Namibia has already achieved the elimination of neonatal tetanus and measles and is recognized by the African Regional Certification Commission (ARCC) as a polio‐free country. (WHO, 2010) Notwithstanding these gains, Namibia has experienced a number of epidemics in recent years, such as cholera, crimean congo haemorrhagic fever, influenza H1N1 (2009), measles, meningococcal meningitis, polio and rift valley fever. (MoHSS, 2011)

Immunisation against the major infectious diseases is one of the eight elements of the PHC approach that has been adopted by the MoHSS. The Expanded Programme on Immunization (EPI) within the Ministry of Health and Social Services (MOHSS) was formally established in June 1990, 3 months after independence. The programme aims to achieve and maintain vaccine coverage above 90% for all antigens (namely tuberculosis, diphtheria, whooping cough (pertussis), tetanus, polio, and measles) in every district with a dropout rate of less than 5% by the year 2010 and beyond, sustain the elimination of neonatal tetanus, poliomyelitis measles by the year 2010 and beyond.

The major focus of EPI programme has been to strengthen routine immunisation. At the same time, EPI acceleration weeks were conducted 4 times a year between 1990 and 1995 in all districts to raise vaccination coverage. Because of this, a significant increase was observed in coverage of all antigens including Measles from 40%-80% during this period. However, from 1996 onwards National Immunization Days (NIDs) were introduced as one of the main strategies for Polio Eradication.

As part of the cross border collaboration between Angola and Namibia, the two countries have partiailly synchronized their NIDs activities since 2007. Recently, the Ministry has introduced the ‘Reach Every District Approach’ (RED) in order to reach every child in all the corners of the country. The aim of this strategy is to give children the opportunity not to miss immunization. Vigilant active and case based surveillance activities have been implemented. (MoHSS, 2008)

Children are considered fully vaccinated when they receive one dose of BCG vaccine, four doses of oral polio vaccine, three doses of Penta, and one dose of measles vaccine. Overall, 69% of children age 12-23 months have received all vaccinations according to the Demographic Health Survey 2006. Ninety-five percent of children have received the BCG vaccination, and 84% have been vaccinated against measles. Coverage for the first dose of DPT and polio is relatively high (95% each).

However, only 83% of children received the third dose of DPT and 79% received the third dose of polio. Comparison of the 2006-07 NDHS results with those of the earlier surveys shows that vaccination coverage in Namibia has increased from 65% in 1992 to the current rate of 69%. However, this progress is not observable in all regions. For example, in Omusati and Omaheke, coverage increased by 39% and 53%, respectively, but Kunene and Karas regions experienced a reduction in immunization coverage. (MoHSS and Macro, August 2008; WHO, 2010)

In September 2009, the MoHSS introduced two new vaccines namely Hepatitis B and Haemophilus influenza type b into the routine immunization programme. The target of the expanded immunization programme (EPI) is to raise access to routine immunization (as measured by DPT-HepB-Hib-3 coverage) from the current 81% to 90% by 2015; however, coverage for all the other antigens will be monitored as well with the aim of attaining herd immunity, that is 90% or more by 2015.

This will be attained through routine immunization of children daily in all health facilities, monthly immunization of children through mobile outreach teams, mass immunization on acceleration days and NIDs and mop-up immunization activities. (MoHSS, under review)

The 2008 Health and Social Services System review recommended the revision of EPI policy to accommodate new vaccines, e.g. hepatitis B, haemophilus influenza B vaccines, pneumococcal vaccine, rota virus vaccines, etc. (MoHSS, 2008) Yellow fever is not present in Namibia. Sentinel surveillance on HIV prevalence has been conducted biannually since 1992, with the last survey completed for 2010. The MoHSS uses a standardized anonymous and unlinked methodology recommended by WHO. (MoHSS, November 2010)

No information is currently available in the public realm on vaccine research and development in Namibia.