EPI shake-up designed to boost infant health

Ugandan children are to benefit from a new vaccine which offers protection against five major childhood diseases in a single shot, as part of the country's new initiative to strengthen the process of the routine immunisation of infants before their first birthday.

Rosamund Lewis, Expanded Programme on Immunisation (EPI) officer for Uganda at the World Health Organisation (WHO), told IRIN on Thursday that the UN agency, in collaboration with the Ugandan authorities, had introduced a new five-in-one vaccine to replace the three-in-one DTP vaccine, which had offered protection against three major diseases: diphtheria, tuberculosis and tetanus.

The new five-in-one vaccine, DTPHibHepB, contains the normal DTP vaccine plus two additional vaccines - for hepatitis B, a disease that attacks the liver and is 100 times more infectious than the HIV/AIDS virus, and haemophilus influenza, which causes pneumonia and meningitis.

Each child was previously required to make at least five immunisation visits before the age of one in order to get protection against six childhood killer diseases. With the revitalised programme - which began on 1 June and was launched officially on Monday, 17 June - each child will receive the benefit of protection against eight diseases, subject to the same number of visits as before, but at no extra cost to mothers, according to Lewis.

"Instead of three-in-one, we now have five vaccines in one shot, given in the same schedule as the previous vaccine. What Uganda is doing is putting in extra effort to strengthen the routine immunisation programme," Lewis said.

The New Vision government-owned newspaper reported on Monday that Ugandan President Yoweri Museveni had launched the revitalisation of immunisation and home-based management of fevers programme, aiming not only at arresting the declining trends in immunisation against six leading child killers: TB, diphtheria, tetanus, polio, measles and whooping cough, but also to include two more vaccines against preventable diseases.

According to the Uganda National Expanded Programme for Immunisation, which runs the programme under the Ministry for Health, about two million Ugandans suffer from hepatitis B. Immunisation coverage throughout the country, which was at its best in 1995, at 82 percent, had declined to 62 percent, the independent Monitor newspaper reported on 14 June.

This decline Lewis attributed to the closure of the country's health outreach centres, which had provided a combination of health services, including immunisation in districts and villages around the country.

"We are now reopening the outreach centres closed in the last couple of years, to bring services closer to the people," she said.

The revitalisation of the EPI programme comprises four components, according to Lewis: the additional two vaccines in the DPT vaccine shot; public mobilisation through an integrated local outreach programme; training of health workers to correctly administer the vaccines; and improvement of Uganda's health infrastructure with respect to distribution of cold storage facilities for vaccines.

The expanded immunisation programme is being implemented in parallel with the ongoing anti-measles campaign in neighbouring Kenya. The week-long campaign, which was launched on Monday, is targeting 14 million children aged between nine months and 14 years throughout the country.

"It is just a coincidence, but a happy coincidence, because it has aspects of the same programme with the similar objectives," Lewis told IRIN.

Uganda conducted a similar anti-measles campaign for all children aged under five years in 2001, but organisers subsequently realised that because this framework had left out many older children, who were then transmitting the disease to younger ones, according to Lewis.

She said that, for this reason, Uganda - and Tanzania - would be conducting their measles campaigns in 2003 for children aged between nine months and 14 years.

"We realised that under-five was not good enough," Lewis said. "We want to do what Kenya is doing - targeting under 15s, which seems to have worked in other countries."