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Analytical summary - Immunization and vaccines development

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In the late 1960s, Sierra Leone was part of the West Africa Smallpox Eradication Programme. Mobile teams from the Ministry of Health’s Endemic Disease Control Unit carried out the vaccinations and the last recorded small pox outbreak was in April 1969.

President Polio.png

In 1978, the Ministry of Health, in collaboration with the United Nations Children’s Fund, United States Agency for International Development, WHO and funds from the Italian Government, established the Expanded Programme on Immunization as an intervention programme to reduce the very high infant mortality rate in Sierra Leone.[1]

From 1978 to 1986, immunization coverage was just 6%. It increased marginally to 24% in 1989 but to achieve a better coverage there was a need to restructure the programme management. Accordingly, with the support of the United Nations Children’s Fund, the Expanded Programme of Immunization was integrated into existing maternal and child health services to constitute the Integrated Maternal and Child Health Programme.

A new programme manager was appointed as team leader for this integrated programme. This was perhaps the most important management strategy. It was responsible for increasing immunization coverage for the lowest antigen at the time (measles) from 24% to 75%, thus achieving the goal for universal child immunization set for 1990 by United Nations agencies, notably the United Nations Children’s Fund and WHO.[1]

Unfortunately, the gains made in 1990 were not sustained. Nevertheless, the routine immunization programme's target in Sierra Leone, in alignment with the African Regional Immunization and Vaccine Development (IVD) Strategic Plan, is set to obtain a 90% immunization coverage rate at national level and 80% in at least 80% of districts (the 90/80 target).[2]

In the bid to strengthen the immunization programme, the Ministry of Health and Sanitation’s integrated Child Health and the Expanded Programme on Immunization programme has been restructured to improve:

  • cold chain and logistics management
  • vaccine management
  • injection safety and waste management
  • data management.
The routine service delivery uses various strategies to reach every district and every target beneficiary, taking into consideration issues of integration, leadership and coordination.[3] Routine data collection showed that in 2010, 89% of eligible children were fully immunized (see table).
Trends in immunization coverage (%) for key antigens, 2005–2010[4]
[4] Serious efforts have been made to eliminate measles and poliomyelitis (polio). A case-based surveillance system for measles and acute flaccid paralysis was developed as part of the integrated surveillance and response system.[2] Three-yearly measles preventive campaigns are being conducted nationwide, to achieve measles elimination. Polio eradication strategies used in Sierra Leone include routine oral polio vaccination immunization (see table)
Immunization schedules for infants (0–11months)[4]
and acute flaccid paralysis surveillance for various polio eradication efforts.[4]


The last case of wild poliovirus was confirmed in 1999. Consequently, Sierra Leone was granted provisional polio-free status in 2007.[2] However, 11 cases of wild poliovirus type 1 were confirmed in 2009 and one case of wild poliovirus type 1 was confirmed in 2010. Thus, this provisional polio-free status will be reversed if the transmission of wild poliovirus is not interrupted, as a country can only be certified polio free when it has been polio free for 3–5 years with good acute flaccid paralysis surveillance indicators.

It is expected that a new rotavirus vaccine will be introduced in 2012.
Tetanus toxoid (TT) immunization schedule for women of childbearing age (15–49 years)[4]

The immunization schedule for infants now includes pentavalent and pneumococcal as well as yellow fever vaccines (see table).[4]

The thrust of maternal and neonatal tetanus elimination lies in the administration of tetanus toxoid, not only to pregnant women but also to all females at the appropriate age, according to schedule (see table).

References

  1. 1.0 1.1 National Policy on Immunization. Government of Sierra Leone, Ministry of Health and Sanitation, Maternal and Child Health Division, 2002
  2. 2.0 2.1 2.2 WHO Country Cooperation Strategy 2008–2013 Sierra Leone (pdf 943.71kb). Brazzaville, WHO Regional Office for Africa, 2009
  3. Child Health Policy. Government of Sierra Leone, Ministry of Health and Sanitation, 2007
  4. 4.0 4.1 4.2 4.3 4.4 4.5 Child Health and the Expanded Programme on Immunization Programme database. Government of Sierra Leone, Ministry of Health and Sanitation, 2010