Programs & Tools:

Global Vaccines and Immunization

CDC's Commitment to Global Immunization

Infectious disease knows no boundaries, especially in today’s world when international travel is so common. When diseases—including vaccine-preventable diseases (VPDs)—break out anywhere in the world, their spread to the United States is only a plane flight away.

CDC’s Global Immunization Division (GID) is involved in one of the most effective of all global public health missions—vaccination against deadly diseases. GID works closely with a wide variety of partners in more than 60 countries to vaccinate children against contagious and potentially serious VPDs. These efforts reduce the risk for VPDs to spread across other countries; ultimately, they protect Americans from sickness and death caused by VPDs that are acquired overseas and carried into the United States by travelers.

The U.S. Congress has provided critical funding to CDC for global vaccination programs since 1991, including specific appropriations for polio eradication, measles mortality reduction, and strengthening routine immunizations. The efforts of CDC, other U.S. agencies, national governments, and multiple partners have led to major progress in addressing global immunization goals and reducing deaths due to VPDs. Polio cases have dropped by 99% since 1988, measles deaths declined by 78% from 2000 through 2008, and more than 2.5 million VPD deaths are prevented each year through routine immunization.

However, much more needs to be done, and even greater improvements in global health are possible. Global polio eradication remains a top priority for CDC and would represent a crowning public health achievement for the entire world. Recent analyses have confirmed the feasibility of global measles eradication, although no date has been set, and multiple challenges remain before this goal can be finalized. Bolstering routine immunization and increasing the use of new vaccines to protect against pneumonia, diarrhea, and meningitis could prevent an additional 2 million child deaths annually.

Immunization is a global health priority for CDC. Vaccines save lives, prevent disease, and are cost-effective and much cheaper than hospitalizations. It has demonstrated large-scale impact on health, with effective strategies and clear targets that lead to dramatic improvements in health. Working closely with public health partners continued significant progress can be made to reduce health disparities and ensure everyone has access to life-saving vaccines.

Making a Difference through Global Immunization

Click on the pictures below to read about successful global vaccination efforts around the world.

CDC Director Frieden Observes Polio Eradication Efforts in India

Global Immunization in Action

Efforts to Eradicate Polio

• Global Immunization Division (GID) staff members work jointly with WHO and national Ministries of Health to plan and monitor polio surveillance and immunization activities in multiple countries worldwide.
• GID also supports other eradication projects such as conducting epidemiologic and vaccine efficacy studies and performing operational research on supplemental immunization activities.
• The Polio and Picornavirus Laboratory in CDC’s Division of Viral Diseases serves as a WHO Global Specialized Laboratory and provides technical and programmatic assistance to the global polio laboratory network overall. CDC’s labs provide critical diagnostic services and genomic sequencing of polioviruses to help guide disease control efforts in many countries. In 2010, this included support for new laboratory procedures now in place that significantly decrease the time it takes to detect and confirm new polio infection from 42 to 21 days. Other new laboratory procedures are helping countries overcome specific operational challenges, enable more rapid detection of wild poliovirus (WPV), and allow for faster response to importations or spread of virus.
• Since 1999, more than 1,450 Stop Transmission of Polio (STOP) team members have participated in 3-month assignments in 62 countries, providing 262 person-years of support at the national and sub-national levels. In 2010 alone, the STOP program assigned 185 professionals to 36 countries to improve surveillance for acute flaccid paralysis (AFP, an early sign of possible polio) and to help plan, implement, and evaluate vaccination campaigns in partnership with WHO.
• Country support through deployment of personnel and other resources.

Successful Global Polio Eradication Efforts

CDC and its international partners have made significant progress over the past 22 years.

• The number of worldwide polio cases has fallen from an estimated 350,000 in 1988 to fewer than 1300 in 2010—a decline of more than 99% in reported cases.
• Three regions of the world are certified polio free—the Americas, Europe, and the Western Pacific. Only four polio-endemic countries (countries that have never interrupted the transmission of wild poliovirus) remain—Afghanistan, India, Nigeria, and Pakistan.
• Two of the four polio-endemic countries (India and Nigeria) are making progress,with India on track to interrupt disease transmission this year.

Worldwide Polio Cases in 1988 and 2010

Four other countries—(Angola, Chad, Democratic Republic of Congo, and Sudan)—had successfully interrupted polio transmission countrywide, but then the virus returned and continued to spread. Many other countries have eradicated polio from some areas within their borders, only to see the disease reintroduced at a later date. Controlling polio is difficult because it spreads easily and people carrying the virus may lack signs and symptoms. The best solution is the total eradication of polio.

The Global Polio Eradication Initiative

Shortly after the World Health Assembly’s 1988 establishment of the goal to eradicate polio, CDC, Rotary International, WHO, and UNICEF came together to found the Global Polio Eradication Initiative (GPEI). Later joined by numerous other partners, including the Bill and Melinda Gates Foundation, the GPEI coordinates worldwide partner activities to combat polio, including the development of periodic strategic plans.

Both polio-endemic countries and those that have re-established poliovirus transmission present a risk of spreading polio disease to other nations. The Global Polio Eradication Initiative Strategic Plan 2010–2012 highlights the new tools, strategies, and tactics needed to interrupt poliovirus transmission in all of these areas.

The Strategic Plan provides guidance for reaching the goal of polio eradication, including

• Establishing an independent review of program milestones on a quarterly basis.
• Developing new vaccines or vaccine strategies.
• Assessing innovative approaches for reaching children previously missed by vaccination efforts because of weak operations management, lack of security, or other factors.

CDC plays a leading role in the GPEI 2010–2012 strategy by preparing quarterly risk assessments that measure progress toward meeting the major milestones outlined in the strategic plan. These reports are intended to assist the Independent Monitoring Board (IMB) and other partners in guiding national polio eradication programs to meet their GPEI milestones [6.79MB - 68 pages].

Planning for the Future – Post Polio Eradication

When the spread of wild polio virus (WPV) is stopped, the international partners expect to plan and carry out a series of activities in various stages to certify the eradication of polio and minimize the possibility that the disease will return. High-quality global surveillance must demonstrate the lack of any WPV for at least three years before eradication can be certified. Laboratories will have to ensure the destruction or safe storage of any WPV infectious and potentially infectious materials. Eventually, the use of the Oral Polio Vaccine (OPV) will be stopped. Calculating the annual global cost savings attributed to discontinuing the use of OPV is extremely complicated*, but savings are estimated to be $40 to $50 billion, underlying the critical importance of getting the job done.

The expansion of the national delivery systems that brought polio vaccine to remote and medically underserved populations, paving the way for other preventive health services, will be a lasting legacy of the GPEI. Using the polio networks, other lifesaving vaccines, insecticide-treated bed nets, and other children’s preventive health services are reaching target populations that were previously not served. The polio networks are also used by first responders when disasters strike (e.g., earthquakes, tsunamis, floods).

Footnote

*For the comparator, which assumes only routine vaccination for polio historically and into the future (i.e., no GPEI), we estimate poliomyelitis incidence using a dynamic infection transmission model and costs based on numbers of vaccinated children. Cost-effectiveness ratios for the GPEI vs. only routine vaccination qualify as highly cost-effective based on standard criteria. We estimate incremental net benefits of the GPEI between 1988 and 2035 of approximately 40–50 billion dollars (2008 US dollars; 1988 net present values). R.J. Duintjer Tebbens et al. / Vaccine 29 (2011) 334–343

Reducing Measles Disease

Measles is a highly contagious respiratory disease caused by a virus. It can result in serious health complications, such as pneumonia and encephalitis, and even cause death. Infants and young children are at higher risk for severe measles. In developing countries, where malnutrition and vitamin A deficiency are common, measles has been known to kill as many as one out of four people. It is the leading cause of blindness among African children. Measles kills almost 1 million children in the world each year.

CDC's Role in the Reducing Global Measles Disease

CDC played a key role, in partnership with the Pan American Health Organization (PAHO), in developing a regional measles elimination strategy in 1996 that lead to the elimination of this disease in the Americas in 2002. As a founding member of the Measles Initiative (MI), launched in 2001, CDC provides both scientific and technical support to partners and countries in other parts of the world to reduce measles deaths. To this end, CDC

• Helps plan, implement, and evaluate measles vaccination campaigns, including micro-planning to eliminate measles in targeted areas.
• Conducts operational research to provide evidence for recommendations to strengthen and guide measles control activities.
• Provides technical assistance to conduct measles outbreak investigations, surveillance reviews, and routine vaccination program evaluations.
• Helps create country-based measles surveillance systems that allow countries to detect and monitor the presence of measles and respond quickly.
• As the global reference laboratory for measles, provides resources for national reference laboratories and provides technical assistance to other global public health laboratories for the collection and shipment of clinical samples for measles RT-PCR (real-time polymerase chain reaction).

Successful Measles Mortality Reduction Efforts

Since the MI began in 2001, more than 700 million children in 60 countries have been vaccinated against measles.

• The number of annual measles deaths has fallen by 78%, dropping from 750,000 in 2000 to about 164,000 in 2008; about 12.7 million measles-related deaths were prevented during these years. This decline alone accounts for about 25% of the overall decline in childhood deaths since 1990.
• All WHO regions, with the exception of South-East Asia, achieved the global 2010 goal of reducing measles deaths by 90% a full 2 years ahead of the target date, although significant challenges continue to threaten these achievements. (See Reductions in Measles Deaths—A Major Achievement at Risk below.)

Measles elimination has been sustained in the Americas since 2002, and important steps are being taken to achieve this goal in three other WHO regions (Europe, Eastern Mediterranean, and Western Pacific) by 2015 or before. In 2009, the African Region adopted the goal of eliminating measles by 2020, and the South-East Asian Region passed a resolution urging countries to mobilize resources to support elimination of measles, with discussions continuing about establishing a target date.

Reductions in Measles Deaths—A Major Achievement at Risk

Earlier successes in measles control are being overshadowed by a resurgence of the disease in sub-Saharan Africa.

• Since mid-2009, more than 200,000 measles cases and at least 1,400 measles deaths have been reported from 28 African countries.
• Because of underreporting, the true number of measles cases and deaths is estimated to be 10- to 20-fold higher.

Why is this happening?

The underlying cause of these outbreaks is not enough vaccination, both low routine first-dose coverage and reduced-quality or delayed supplementary immunization campaigns that provide a second opportunity for measles vaccination. The outbreaks in Africa, along with the continued high numbers of measles deaths occurring in India, threaten to reverse the progress made in reducing measles mortality worldwide.

Estimated number of measles deaths worldwide, 2000–2008,^a and projections of possible resurgence in measles deaths worldwide, 2009–2013

Although past decreases in measles deaths have made a critical contribution toward achieving the Millennium Development Goal #4, experts’ fears are growing that these gains could be lost because of declining political and financial commitment to measles control.

• Financial support for the Measles Initiative decreased from U.S. $150 million in 2007 to U.S. $50 million in 2010.
• Many countries have not sustained national public health resource commitments to ensure high first-dose routine measles vaccination coverage as well as the provision of many other routine antigens.
• Many countries with a high-priority need for measles control programs have not been able to raise the expected 50% of operational costs for campaigns, resulting in postponement of scheduled vaccination campaigns and cutbacks in the range of targeted age groups.
• WHO estimates that reduced financial and political commitment to measles control during 2010–2013 could, as a worst-case scenario, result in 200,000 more measles deaths in 2011 and at least 500,000 measles deaths worldwide in 2013 alone.
• The gains made in reducing measles mortality over the past decade will be lost unless more resources are provided now to fully implement planned vaccination activities and set up laboratory-backed surveillance for measles cases.

Strengthening Routine Immunization Programs Worldwide

An estimated 130 million infants are born around the world each year. Protecting these newborns from vaccine preventable diseases (VPDs) requires an organized, accessible, and well functioning immunization program as a key component of a country's public health program.

Use of basic vaccines, including measles, polio, and diphtheria-tetanus-pertussis (DTP) vaccine, prevents an estimated 2.5 million deaths per year among children younger than age 5. Overall, global coverage with three doses of DTP—a performance measure for routine vaccination programs—increased from 74% to 82% during the past decade.

When strong routine immunization programs are combined with effective disease surveillance programs, the result is less disease and fewer deaths from VPDs. Effective routine immunization programs maintain high vaccine coverage, decrease waste and shortages of vaccines, allow earlier detection of disease outbreaks, and lessen the need to rely on resource-intensive special vaccination campaigns.

Although immunization reaches more children than any other single intervention, 24 million children each year still fail to get immunized, including many who do not finish a series of immunizations after they have started; the reasons for this are as varied and complex as the populations themselves. Children are a particular concern in places where immunization programs do not exist or where they are poorly managed, lack adequate resources, exclude certain members of society, or are difficult to access. If vaccination programs do not reach these children, they are also unlikely to receive other needed health services.

CDCs Role in Strengthening Immunization Programs Worldwide

CDC works in partnership with countries and at the regional and global levels to provide technical expertise and guidance to strengthen and expand the routine delivery of immunizations. This work includes

• Helping design and evaluate strategies to enhance disease surveillance systems, improve vaccine coverage and data quality, and ultimately reduce the presence of VPDs.
• Assisting in training of national immunization technical advisory bodies.
• Making pre-vaccine introduction assessments and post-introduction evaluations.
• Building capacity and in selected countries for implementing routine immunization strategies.
• Helping evaluate projects that integrate non-vaccine interventions with routine immunization programs, such as malaria-preventing bed nets. Or Helping define the most efficient and effective models for integrating additional interventions, such as malaria-preventing bed nets, with routine immunization programs,
• Strengthening routine immunization delivery systems and programs for the introduction of new and underutilized vaccines.

Promoting New and Underutilized Vaccines Internationally

Despite the extraordinary progress in reducing deaths and disease through more widespread vaccination programs, many children still do not fully benefit from all available vaccines. WHO estimates that approximately 8.8 million children under 5 years of age die each year around the world, mostly in poor countries of Asia and Africa. More than 2 million of these deaths, or over 20%, could be prevented by widespread use of vaccines that are currently available in developed countries.

For example, tetanus is still common in many parts of the world, and it kills thousands of babies each year. In places where birthing conditions are not sanitary, tetanus in newborns is a real threat. The World Health Organization estimates that 59,000 newborns died of tetanus in 2008.

These child deaths are largely preventable. New vaccines are available to protect both children and adults, including the rotavirus, pneumococcal conjugate (PCV), and human papilloma virus (HPV) vaccines, and underused vaccines include Haemophilus influenzae type b (Hib), Hepatitis B, rubella and seasonal influenza vaccines. Other vaccines, such as Japanese encephalitis, typhoid, cholera, yellow fever, and meningococcal group A [33KB - 1 page] vaccines, may be more specific to the public health needs of a particular region or group of countries where these devastating diseases are prevalent. Widespread introduction of these new and underused vaccines to all countries depends on overcoming key challenges:

• Having an adequate vaccine supply.
• Improving immunization system capacity.
• Sustaining partnerships for synergy in reaching targets.
• Having adequate financial support.

Lifesaving Impact of Hib, Rotavirus, and PCV Vaccines

According to the GAVI Alliance (GAVI), the time is now optimal to speed up introduction of Hib, PCV, and rotavirus vaccines—using them can result in a 40% to 60% reduction in the 2.9 million annual deaths caused by pneumonia and diarrhea among children younger than age 5. WHO recommends all three vaccines for all countries. CDC provides scientific and technical support to partners, including WHO, the GAVI Alliance, and ministries of health, to support and guide the global introduction and use of new and underused vaccines.

HPV Vaccine

HPV vaccines prevent cervical cancer and other less common cancers that are caused by human papillomavirus (HPV). In addition to cancer, HPV* can cause other global health problems such as genital warts.

Footnote

*HPV is a common virus that is easily spread by skin-to-skin contact during sexual activity. It is possible to have HPV without knowing it, so it is possible to unknowingly spread HPV to another person. Safe, effective vaccines are available to protect both females and males against some of the most common types of HPV and the health problems the virus can cause. For more information on the HPV vaccine, visit the HPV website.

Meningococcal Group A Vaccine

Approximately 450 million people are at risk for meningitis* in 25 African countries commonly referred to as the “meningitis belt,” from Ethiopia in the east to Senegal in the west. However, there is now promise that this devastating public health threat will soon begin to wane. A new meningococcal group A vaccine—MenAfriVac™—became available for use in Africa in 2010 priced at just U.S. $0.40 per dose, an affordable price for Africa.

Footnote

*Bacterial meningitis is a contagious infection of the brain membranes. It kills about 10% of patients, and about 25% suffer long-term injury such as deafness and brain damage. In Africa, children in particular are at risk. A single case of meningitis can drive an African family into a spiral of poverty from which it may never recover.

MenAfriVac™ was developed specifically to protect against the meningitis strain most destructive to people living in the meningitis belt. It is targeted to children and young people between the ages of 1 and 29 and can provide up to 10 years of protection. CDC staff in the Division of Bacterial Diseases collaborated with The Bill and Melinda Gates Foundation-funded Meningitis Vaccine Project (MVP) — which includes PATH, WHO, FDA, the Health Protection Agency, and the National Institute for Biological Standards and Control—to help bring this low cost-vaccine through clinical development to public health use.

The Next Generation of Vaccines

Since the development of the first vaccine against smallpox by Edwin Jenner more than 200 years ago, vaccines have made significant reductions of disease and deaths possible wherever they were used. Traditionally, the development of vaccines has used two techniques: attenuation and inactivation. Today, new procedures in vaccine production include genetic engineering, purification of microbial elements, creation of attenuated disease mutants, and manipulation of proteins including DNA, RNA, and polysaccharides. These new vaccine development techniques are being used to create vaccines for both non-infectious and infectious diseases.

Research is currently underway on developing new and improved vaccines against human immunodeficiency virus (HIV), tuberculosis (TB),and malaria. When available, this next generation of vaccines has the potential to significantly reduce the 5.5 million deaths worldwide (WHO 2000) that are caused by HIV, TB, and malaria.

Evaluation and Research

GID and other CDC infectious disease programs actively support the evaluation and introduction of available and underused vaccines that have the potential to greatly reduce global illness and death caused by VPDs. CDC also actively supports research that will lead to the creation of new vaccines. Protection from leading killers such as HIV, malaria, and tuberculosis is still desperately needed in developing countries.

Global Partners

Because of the scope and intensity of global health challenges, no single country, agency, or institution can work alone to meet them. To contribute to shared global immunization initiatives, CDC works in close partnership with a wide array of public- and private-sector agencies and institutions to shape global health policies and help support national immunization programs.

Ministry of Health (MOH) Partnerships

CDC provides technical assistance and program guidance to ministries of health (MOH) at the country level. This assistance helps strengthen and expand countries' abilities to create, carry out, and evaluate immunization programs.

CDC's technical and programmatic support helps build national capacity to carry out supplemental immunization efforts for diseases such as polio and measles and enhance country efforts to deliver these vaccines routinely. Routine immunization delivery often includes vaccination against maternal and neonatal tetanus, pneumonia, meningitis, and rotavirus, as well as the provision of other newly developed but underused vaccines. In some countries, national immunization programs also have distributed free anti-malarial mosquito nets, water purification kits, and vitamin A and provided routine child development checkups.

In other efforts, GID also helps build in-country capacity by training and developing public health professionals at all levels. GID staff members train MOH personnel to perform VPD surveillance and monitoring, conduct outbreak investigations, and carry out routine and supplementary vaccination campaigns. GID experts also assist MOH staff in developing high-quality vaccination data reporting systems that will support strategic management and assessment of country-level VPD efforts. Often these country-level efforts lead to enhanced regional capacity to sustain effective vaccination programs.

International Organization Collaborations

Meeting the challenge of preventing VPDs globally requires working closely with many international organizations, including the World Health Organization (WHO), UNICEF, the United Nations Foundation (UNF), World Bank, Organization of the Islamic Conference (OIC),and other development partners.

Through WHO and UNICEF, GID provides technical and scientific expertise on vaccination and immunization issues, along with financial support to conduct VPD surveillance and supplementary and routine immunization activities. Often GID scientists and technical experts serve in WHO's international, regional, and in-country positions, providing unique opportunities for collaboration. Through UNICEF, GID purchases polio and measles vaccines, supports in-country social mobilization efforts, and provides technical guidance to countries. These efforts help expand countries’ current vaccination programs as well as add newly developed but underused vaccines such as pneumococcal conjugate, meningococcal, and rotavirus vaccines.

Public-Private Partnerships

Through public and private partnerships (PPPs), GID works with public agencies, nongovernmental organizations, and private groups to

• Achieve common disease-control objectives.
• Leverage new financial resources for global immunization activities in developing countries.
• Extend vaccination efforts to hard-to-reach populations.

PPPs help GID and private-sector entities improve their efforts by jointly defining objectives, programs, and implementation plans. These mutually beneficial arrangements

• Enhance local and international capacity to deliver high-quality vaccination services and disease prevention programs.
• Multiply the impact of each sector by combining their core competencies.
• Fully integrate the initiative with the future health and development plans of partner countries.

Most importantly, the targeted communities and populations benefit from better health.

GID also works with many private organizations and multilateral alliances committed to supporting global immunization, including

• Rotary International, which for more than 20 years has worked to eradicate polio worldwide through its financial support and the direct work of Rotary members.
• The Bill and Melinda Gates Foundation, which provides funding for the "Decade of Vaccines" initiative and global vaccination projects primarily focusing on efforts to eradicate polio.
• The Measles Initiative, a partnership led by the American Red Cross to reduce global measles deaths through vaccination.
• The Global Alliance for Vaccine and Immunizations (GAVI Alliance), which works to increase vaccine access in poor countries that could not otherwise afford to provide vaccines.

Closer to home, the CDC Foundation also provides financial support for global vaccination projects.

U.S. Government Collaboration

At the federal level, as part of CDC and the U.S. Department of Health and Human Services (HHS), GID’s staff reports to, liaises with, and gets direction from the HHS Office of Global Health Affairs (OGHA), which promotes the health of the world’s population by advancing DHHS global strategies and partnerships. Through HHS, GID works with USAID and the Department of State to promote international cooperation between governments and provide support for disease prevention and immunization programs.

Finally, several other divisions in CDC, both in NCIRD and other centers, also work on global immunization activities. GID works closely with these centers and divisions to leverage support for global immunization efforts.

Recent Reports

• 2010 GID Publications
  1. Behl AS, Vijayaraghavan M, Nordin JD, Maciosek MV, Strebel PM. Community-level incentives to increase the use of vaccination services in developing countries: an idea whose time has come? Vaccine. 2010;28(38):6123-4.
  2. Cairns KL, Nandy R, Grais RF. Challenges in measuring measles case fatality ratios in settings without vital registration. Emerg Themes Epidemiol. 2010;7(1):4.
  3. Ciccone FH, Carvalhanas TR, Afonso AM, Flannery B, Waldman EA. Investigation of measles IgM-seropositive cases of febrile rash illnesses in the absence of documented measles virus transmission, State of São Paulo, Brazil, 2000-2004. Rev Soc Bras Med Trop. 2010;43(3):234-9.
  4. Cui F, Li L, Hadler SC, Wang F, Zheng H, Chen Y, et al. Factors associated with effectiveness of the first dose of hepatitis B vaccine in China: 1992-2005. Vaccine. 2010;28(37):5973-8. Epub 2010 Jul 15.
  5. Duintjer T RJ, Pallansch MA, Alexander JP, Thompson KM. Optimal vaccine stockpile design for an eradicated disease: application to polio. Vaccine. 2010; 8(26):4312-27.
  6. Goodson JL, Perry RT, Mach O, Manyanga D, Luman ET, Kitambi M, et al. Measles outbreak in Tanzania, 2006-2007. Vaccine. 2010 ;28(37):5979-85.
  7. Grassly NC, Jafari H, Bahl S, Durrani S, Wenger J, Sutter RW, et al. Asymptomatic wild-type poliovirus infection in India among children with previous oral poliovirus vaccination. Journal of Infectious Diseases. 2010;201(10):1535-43.
  8. Khetsuriani N, Imnadze P, Baidoshvili L, Jabidze L, Tatishili N, Kurtsikashvili G, et al. Impact of unfounded vaccine safety concerns on the nationwide measles-rubella immunization campaign, Georgia, 2008. Vaccine. 2010;28(39):6455-62. Epub 2010 Jul 30.
  9. Kulkarni, Vanden Eng J, Desrochers RE, Cotte AH, Goodson JL, Johnston A, et al. Contribution of integrated campaign distribution of long-lasting insecticidal nets to coverage of target groups and total populations in malaria-endemic areas in Madagascar. Med Hyg. 2010;82(3):420-5.
  10. Olsen SJ, Supawat K, Campbell AP, Anantapreecha S, Leamsuwan S, Tunlayadechanont S, et al. Japanese encephalitis remains an important cause of encephalitis in Thailand. Int J Infect Dis. 2010;14:e888-92.
  11. Robinson JS, Featherstone D, Vasanthapuram R, Biggerstaff BJ, Desai A, Ramamurty N, et al. Evaluation of Three Commercially Available Japanese Encephalitis Virus IgM Enzyme-Linked Immunosorbent Assays. Am. J. Trop. Med. Hyg. 2010;83(5):1146–1155.
  12. Rocha Mello M, Moraes J, Barbosa H, Flannery B. Participation in national polio immunization days: results of a vaccine coverage survey among children in 27 Brazilian cities. Rev Bras Epidemiol. 2010;13(2):278-288.
  13. Sobel HL, Mantaring JB 3rd, Cuevas F, Ducusin JV, Thorley M, Hennessey KA, Nyunt-U S. Implementing a national policy for hepatitis B birth dose vaccination in Philippines: Lessons for improved delivery. Vaccine. 2010.
  14. Sutter R W, John J, Jain H, Agarkhedkar S, Ramanan P V, Verma H, et al. Immunogenicity of bivalent types 1 and 3 oral poliovirus vaccine: a randomised, double-blind, controlled trial. The Lancet. Volume 376, Issue 9753, Pages 1682 – 1688.
  15. Tavares de Carvalho M, Bulhões M, Rocha CM, Flannery B. Brazil: vaccination campaign to eliminate rubella. PAHO Immunization Newsletter. 2009;31(2):1-4.
  16. Teixeira A, Samad S, Flannery B. Brazil implements workshops to improve vaccination coverage at local level. PAHO Immunization Newsletter. 2010;32(3): 4-5.
  17. Veras MA, Flannery B, de Moraes JC, da Silva Teixeira AM, Luna EJ; the Vaccine Coverage Survey 2007 Group. Yellow fever vaccination coverage among children in Brazilian capitals. Vaccine. 2010;28(39):6478-82.
  18. Wang SA. Monitoring the coverage and impact of human papillomavirus vaccine – report of WHO meeting, November 2009 [265KB - 12 pages]. Weekly Epidemiological Review. 2010;85:237-243.
  19. Wang SA. Report of the meeting on HPV vaccine coverage and impact monitoring. [1.91MB - 65 pages] World Health Organization, Geneva, Switzerland, WHO. 2010.
  20. Wassilak S, Orenstein W. Challenges faced by the global polio eradication initiative. Expert Review of Vaccines. 2010;9(5):447-9.
  21. Yin Z. Wang H, Yang J, Luo H, Li Y, Hadler SC, et al. Acute Meningitis and Encephalitis Syndrome (AMES) Study Group. Japanese encephalitis disease burden and clinical features of Japanese encephalitis in four cities in the People's Republic of China. American Journal of Tropical Medicine & Hygiene. 2010;83(4):766-73.
• CDC Assessment of Risks to the Global Polio Eradication Initiative (GPEI) Strategic Plan 2010-2012
  1. 2011 Third Quarter Report (October, 2011) [275KB - 27 pages]
     • Country Profile Supplement [514KB - 48 pages]
  2. 2011 Second Quarter Report (July, 2011) [445KB - 26 pages]
     • Country Profile Supplement [477KB - 46 pages]
  3. 2011 First Quarter Report (January–March, 2011) [837KB - 65 pages]
     • Country Profile Supplement [278KB - 46 pages]
     • Methods Supplement [1.16MB - 25 pages]
  4. 2010 Third Quarter Report (January–September, 2010) [1.45MB - 52 pages]
     • Country Profile Supplement [1.77MB - 40 pages]
  5. 2010 First and Second Quarter Report [1.22MB - 65 pages]
     • Country Profile Supplement [7.32KB - 36 pages]
• CDC Global Immunization Strategic Framework 2011 to 2015
• Global Disease Elimination and Eradication as Public Health Strategies. MMWR. 1999;48:Supplement
• Measles Program In Americas Cited As Example For World. Pan American Health Organization. 2003.
• Disease Control Priorities in Developing Countries. 2nd edition, Disease Control Priorities Project.
• United Nations Millenium Development Goals
• WHO statistics and graphics
• WHO country profile selection

About the Global Immunization Division (GID)

Read more about GID’s global activities.

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