Plan of Eradication of Poliomyelitis 1987-1990
In 1985, despite the vaccination efforts made in previous years, Colombia was still experiencing cases of Polio. After a meticulous analysis of the technical capacity and the technology available, the country subscribed, along with others of the Americas, to the commitment to eradicate Polio in its territory and to offer access to vaccination services to all children by 1990.
The main objectives of the Polio Eradication Initiative were:
In 1987, two national days - July 25 and September 26 - and one week of intensification from November 9-14 were planned to interrupt the Wild Poliomyelitis Virus spread by applying two doses of vaccine to all the children below five years of age. On the two first dates, vaccination sites were located in the local health agencies, as well as in other locations, to vaccinate as many children as possible. From November 9-14, the mass media promoted the regular vaccination programme in order to stimulate caregivers of children below five years of age that had previously begun their vaccination scheme to take those children to complete the process.
For 1988 it was decided to repeat the experience of the previous year emphasising the eradication of Polio, with the idea of "flooding" the environment with vaccine antibodies. Two national days - May 28 and July 30 and the week between September 26 and October 1 were established, during which mass communication messages encouraged citizens to take children below 5 years of age to established places to complete their schemes of vaccination.
During 1989, in addition to increasing the vaccination coverage with all the vaccines of the EPI in the intended population, it was intended to increase coverage with Tetanus Toxoid vaccine in pregnant women and in women of fertile age in endemic zones, with the purpose of diminishing the incidence of neonatal Tetanus and eliminating it for 1995. The objective to eradicate Polio remains. The goal established for the national vaccination days was to administer two doses of Oral Polio Vaccine (OPV) to 3,750,000 children below five years of age.
In 1990 the emphasis remained on the eradication of the Polio, but the other vaccines of the EPI were also applied in both national vaccination days. The goal to be reached in each municipality was coverage of over 80% with all vaccines in the group of children below one year of age and susceptible children in the group from 1 to 4 years of age. The interruption of the circulation of Polio by applying two doses of vaccine to all children below five years of age, and to vaccinate all women of fertile age of the municipalities classified as high risk for neonatal Tetanus.
The main objectives of the Polio Eradication Initiative were:
- to interrupt the circulation of the Wild Poliomyelitis Virus by saturating the environment with the vaccine. This meant applying two vaccine doses to all the children below five years of age, whether or not they had completed their vaccination scheme;
- to consolidate vaccination with the regular programme by means of the improvement of the canalisation/channelling process used in the development of vaccination against Polio; and
- to involve all the social sectors in solving the health problems that affects each community, through its participation.
In 1987, two national days - July 25 and September 26 - and one week of intensification from November 9-14 were planned to interrupt the Wild Poliomyelitis Virus spread by applying two doses of vaccine to all the children below five years of age. On the two first dates, vaccination sites were located in the local health agencies, as well as in other locations, to vaccinate as many children as possible. From November 9-14, the mass media promoted the regular vaccination programme in order to stimulate caregivers of children below five years of age that had previously begun their vaccination scheme to take those children to complete the process.
For 1988 it was decided to repeat the experience of the previous year emphasising the eradication of Polio, with the idea of "flooding" the environment with vaccine antibodies. Two national days - May 28 and July 30 and the week between September 26 and October 1 were established, during which mass communication messages encouraged citizens to take children below 5 years of age to established places to complete their schemes of vaccination.
During 1989, in addition to increasing the vaccination coverage with all the vaccines of the EPI in the intended population, it was intended to increase coverage with Tetanus Toxoid vaccine in pregnant women and in women of fertile age in endemic zones, with the purpose of diminishing the incidence of neonatal Tetanus and eliminating it for 1995. The objective to eradicate Polio remains. The goal established for the national vaccination days was to administer two doses of Oral Polio Vaccine (OPV) to 3,750,000 children below five years of age.
In 1990 the emphasis remained on the eradication of the Polio, but the other vaccines of the EPI were also applied in both national vaccination days. The goal to be reached in each municipality was coverage of over 80% with all vaccines in the group of children below one year of age and susceptible children in the group from 1 to 4 years of age. The interruption of the circulation of Polio by applying two doses of vaccine to all children below five years of age, and to vaccinate all women of fertile age of the municipalities classified as high risk for neonatal Tetanus.
Communication Strategies
With the objective of eradicating Polio from the country, different strategies that originated during previous vaccination experiences were applied and enriched with community work and participation through methodologies like the "canalisation" (or channelling) strategy, the National Vaccination Days and the strengthening of epidemiologic monitoring, among others.
"Canalisation" (or Channelling):
For the application of this strategy, the functionaries of the local health departments created a map of their respective communities and they visited house to house all the families of the area in the company of a community leader. They made a census of children of the appropriate age and identified those not vaccinated or with incomplete vaccination schemes, educated people on health topics, and set an appointment with parents to take their children to be vaccinated. In this way, a permanent bond between the members of the community and the health agencies was established in order to direct the users or susceptible population towards vaccination services.
National Vaccination Days:
Special days during which an increase of the activities of the regular vaccination programme were made, with the support of diverse institutions, the community, and with mass media promotion. It was decided to carry out these days in a manner that flooded the entire country with vaccine, in the shortest possible time.
Mop-Up Operations (Operación Barrido):
This temporary strategy was designed as part of the Polio Eradication Plan. It consisted of administering a dose of Polio vaccine to all children below five years of age residing in the high-risk municipalities (all infected municipalities with demonstrated circulation of the wild virus, with repetition of confirmed cases during last the three years, with low vaccination coverage, or that present a probable or confirmed case of Polio). This was done through house-to-house visits and by applying the vaccine even though children had completed their vaccination scheme. The municipal authorities are responsible for Mop-Up Operations with the communities' participation.
Intensified Epidemiological Vigilance:
In order to carry out the monitoring tasks diverse mechanisms were applied:
The EPI designed a training module for the Eradication and Epidemiological Monitoring of Polio, which was introduced through seminars beginning in 1987. With this module and other training tools offered, the functionaries involved with the eradication plan were trained. Professors from medical faculties of academic institutions, as well as other officials and key members of the community, such as indigenous promoters and farmer women, also were trained. Other activities had to do with the collection of data on coverage, non-vaccination causes, cost-benefit relation and evaluation of the vaccination processes and activities. Measurement of impact of the epidemiological monitoring of Polio and the periodic publication of a national PAI bulletin were also carried out.
"Canalisation" (or Channelling):
For the application of this strategy, the functionaries of the local health departments created a map of their respective communities and they visited house to house all the families of the area in the company of a community leader. They made a census of children of the appropriate age and identified those not vaccinated or with incomplete vaccination schemes, educated people on health topics, and set an appointment with parents to take their children to be vaccinated. In this way, a permanent bond between the members of the community and the health agencies was established in order to direct the users or susceptible population towards vaccination services.
National Vaccination Days:
Special days during which an increase of the activities of the regular vaccination programme were made, with the support of diverse institutions, the community, and with mass media promotion. It was decided to carry out these days in a manner that flooded the entire country with vaccine, in the shortest possible time.
Mop-Up Operations (Operación Barrido):
This temporary strategy was designed as part of the Polio Eradication Plan. It consisted of administering a dose of Polio vaccine to all children below five years of age residing in the high-risk municipalities (all infected municipalities with demonstrated circulation of the wild virus, with repetition of confirmed cases during last the three years, with low vaccination coverage, or that present a probable or confirmed case of Polio). This was done through house-to-house visits and by applying the vaccine even though children had completed their vaccination scheme. The municipal authorities are responsible for Mop-Up Operations with the communities' participation.
Intensified Epidemiological Vigilance:
In order to carry out the monitoring tasks diverse mechanisms were applied:
- Creation of the Immediate Answer Groups, Grupos de Respuesta Inmediata (GRI), in all the levels of health attention. These groups were intended to investigate every suspicious or probable case of Polio and to take the necessary measures of control. They were created at the national level in 1987 as a mechanism of support for the eradication of Polio, but in 1989 they extended to the Sectional Health Services and to the investigation of other diseases.
- Creation of Analysis Units in every one of the health agencies. The function of these units was to review exhaustively the situation of vaccine-preventable diseases with an emphasis on Polio.
- Sentry Institutions were established in all clinics and hospitals, whether paediatric or general, private or public, where the infant population went for health services. With the purpose of achieving the eradication of Polio, all health institutions of the country were declared sentry institutions for the monitoring of Polio, with dependency of the respective regional or university hospital.
- Community Committees for Poliomyelitis Monitoring: Their objective was to support the detection of cases of Polio and its monitoring in the infected municipalities.
- Monitoring of post-vaccine complications: In case of disease or death of children whose relatives attributed it to the vaccine applied during the National Days of Vaccination, free medical attention and exhaustive investigation of the cause of death were guaranteed to clarify any citizen's doubts related to the application of the vaccine.
The EPI designed a training module for the Eradication and Epidemiological Monitoring of Polio, which was introduced through seminars beginning in 1987. With this module and other training tools offered, the functionaries involved with the eradication plan were trained. Professors from medical faculties of academic institutions, as well as other officials and key members of the community, such as indigenous promoters and farmer women, also were trained. Other activities had to do with the collection of data on coverage, non-vaccination causes, cost-benefit relation and evaluation of the vaccination processes and activities. Measurement of impact of the epidemiological monitoring of Polio and the periodic publication of a national PAI bulletin were also carried out.
Development Issues
Immunisation and Vaccines, Children, Health.
Key Points
According to organisers, the fact that in two consecutive years, 1987 and 1988, and in two days of each one of those years nearly 3,300,000 children below five years of age were vaccinated against Polio, demonstrates the great social mobilisation that the plan generated and the increasing participation of the community in its development.
In 1987 the coverage in children below one year of age with OPV was of 84%, with Measles vaccine of 66%, with DPT of 65% and with BCG of 85%.
At the end of 1988 the coverage in children below one year of age with OPV achieved 86%, with Measles vaccine to 71%, DPT to 70% and BCG to 89%.
The results of 1989 show that 60% of the municipalities reached over 80% coverage with Polio vaccine. In children below one year of age the coverage with Measles vaccine coverage was of 74%, with DPT of 78%, BCG of 94% and Polio vaccine of 89%.
The Rotary Club got involved in 1985 in order to support the eradication of the Polio mainly through the work of its members and the financing of the OPV vaccine.
In 1987 the coverage in children below one year of age with OPV was of 84%, with Measles vaccine of 66%, with DPT of 65% and with BCG of 85%.
At the end of 1988 the coverage in children below one year of age with OPV achieved 86%, with Measles vaccine to 71%, DPT to 70% and BCG to 89%.
The results of 1989 show that 60% of the municipalities reached over 80% coverage with Polio vaccine. In children below one year of age the coverage with Measles vaccine coverage was of 74%, with DPT of 78%, BCG of 94% and Polio vaccine of 89%.
The Rotary Club got involved in 1985 in order to support the eradication of the Polio mainly through the work of its members and the financing of the OPV vaccine.
Partners
Ministry of Health, UNICEF, PAHO/WHO, National Health Institution, Rotary Club international.
Sources
Plan of Eradication of the Poliomyelitis. Extended Program on Immunisations (PAI ). Republic of Colombia. Ministry of Health. Direction of Medical Attention. Group of Immunisations. Bogota, September of 1988. (Plan de Erradicaci
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