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This toolkit has been created and it is updated as a resource to support managers of the Expanded Programs on Immunization (EPI) in the Region, as well as their teams, in all aspects of the planning, monitoring, reporting and evaluation of immunization programs.

This toolkit also serves as a reference library for Technical Advisory Group (TAG) for Immunization recommendations, policy resolutions from PAHO’s Governing Bodies on immunization-related topics, pertinent guidelines and field guides, and key publications.

EPI components

EPI Planning

The annual plan of action of the Expanded Program on Immunization (EPI) is a managerial tool for programming and monitoring that facilitates prioritization, to foster efficient and timely achievement of objectives and goals. Developing a plan of action enables the EPI to:

Implement activities on schedule that are consistent with defined objectives and strategies
Harmonize actions and actors around a common objective
Obtain and dedicate the necessary resources
Monitor and evaluate progress toward the defined objectives

The format for the EPI plan of action was updated to include standardized definitions for 12 common technical areas of work that should be included in all plans and to include more detailed information concerning the costs of the Program.

Annual EPI plans of action should be elaborated by national immunization programs at the end of the prior calendar year, or at the latest, at the beginning of each new year. Country plans should then be submitted to PAHO/WHO, where they will serve as the basis for all technical cooperation efforts provided by the Organization.

This section contains the guidelines for countries’ annual EPI plan of action.

EPI Plan of Action Guidelines Instructions for developing the annual plan of action of the Expanded Program on Immunization

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Data Monitoring and Reporting

Monitoring and reporting of immunization-related data is a key element of the EPI. The analysis of immunization indicators has been essential to monitor the progress of the EPI, as well as to identify areas that require more work in order to achieve the selected goals.

A key tool for data collection is the PAHO/WHO/UNICEF Joint Reporting Form (JRF) for immunization data, which countries complete on an annual basis.

Data collected through the JRF are utilized in a multitude of ways, including to:

Guide regional immunization strategies
Provide inputs for WHO/UNICEF’s coverage estimates
Estimate the burden of vaccine-preventable diseases
Monitor progress towards the Sustainable Development Goals (SDGs)
Monitor the implementation of the Immunization Agenda 2030 and regional action plan
Provide systematic information on immunization to all those who require it.

Immunization Brochure

Immunization throughout the life course

Immunization Dashboard

WHO/UNICEF Immunization Coverage Estimates

Immunization Data and Statistics

JRF information

eJRF portal (authorized user access)

FAQs: JRF and WUENIC estimates

Tools for monitoring the coverage of integrated public health interventions

Vaccination and deworming of soil-transmitted helminthiasis

Electronic Immunization Registry

Practical Considerations for Planning, Development, Implementation and Evaluation

Surveillance of Vaccine-preventable Diseases

Surveillance is the systematic and continuous process of data collection, analysis, interpretation, and dissemination for use in planning, implementation, and evaluation of public health practice activities.

For the epidemiological surveillance of vaccine-preventable diseases targeted for elimination and eradication, PAHO developed the Polio Eradication Surveillance System (PESS) and later, the Measles Elimination Surveillance System (MESS). In order to integrate systems, in 2009, PAHO made available to countries the Integrated Surveillance Information System (ISIS) for polio, measles, rubella and congenital rubella syndrome; the transition to ISIS has been gradual. Some countries do not use ISIS in favor of using their own IT tools; for these countries, PAHO is developing data bridges to import information from national tools or databases into ISIS. Based on the successes of the program and following the indications of the countries, PAHO is building a new surveillance information system that will help the countries to improve their surveillance.

Additionally, to provide a standardized computerized tool for the countries in the Region that are part of the rotavirus and invasive pneumonia and meningitis bacterial disease surveillance network (sentinel hospital-based surveillance), a New Vaccines Surveillance System (VINUVA) was created in 2011, in 2018 this system was replaced by VINUVA aggregate. “VINUVA Agregado” can be accessed by registered users at:

VINUVA AgGregaTE

Since 2015, an online case-based surveillance system for rotavirus and invasive pneumonia and meningitis bacterial infections is available for sentinel hospitals, national and reference laboratories that belong to the regional and global networks. Registered users can access the database at:

VINUVA CASES

Neonatal tetanus elimination: fleld guide; 2005

Poliomielitis erradication: field guide; 2005 (in spanish)

Control of Yellow Fever: field Guide; 2005

Epidemiological surveillance of diarrhea caused by rotavirus: field guide; 2007 (in spanish)

Measles elimination: field guide; 2007 (in spanish)

Introduction and implementation of new vaccines: field guide; 2009 (in spanish)

Surveillance of bacterial pneumonias and meningitis in children under 5 years of age. Field guide; 2nd ed., 2019 (in spanish)

Control of diphtheria, pertussis, tetanus, Haemophilus influenzae type b infection and hepatitis B: field guide; 2006 (in spanish)

Measles Programmatic Risk Assessment Tool

VINUVA Aggregate (authorized user access)

VINUVA Cases (authorized user access)

Vaccine Safety

An information system on vaccine safety is an essential tool to support decision-making, as the risks generated by the proposed interventions are being permanently evaluated. Building public confidence in vaccines requires having relevant information about their safety and effectiveness that reliably answers questions and concerns.

In the Region of the Americas, vaccines have reached high levels of acceptance and confidence in their effectiveness to reduce the frequency and impact of many infectious diseases, compared to other areas of the world. However, the public has expressed more doubts about the safety of vaccines than about their effectiveness.

In the current context of the emergency due to the COVID-19 pandemic, in which the rapid deployment of new vaccines has been required and have had to go through emergency authorization schemes, an emphasis has been placed on activities that guarantee the Vaccine safety. These include the surveillance of Events Supposedly Attributable to Vaccination or Immunization (ESAVI).

It is essential to continue strengthening ESAVI surveillance systems with a strategy that manages to generate technical capacities from the local level to strengthen information systems and the use of technologies to carry out high-quality surveillance work.

The Immunizations Unit in conjunction with the Medicines and Health Technologies Unit work together for the implementation of the regional system for the surveillance of ESAVI, which aims to monitor the security situation of vaccines in the region, in addition to measuring signal detection and population causality to analyze the relationship between observed adverse events and vaccines.

Vaccine Safety: An interinstitutional work

PAHO Vaccine Safety

Vaccine Safety Net

Manual for Surveillance of Events Supposedly Attributable to Vaccination or Immunization in the Region of the Americas

Cold Chain

Today’s immunization cold chain and supply chain operations have been one of the key elements in expanding the provision of daily immunization services and allowing more people to be protected from vaccine-preventable diseases. When the PAHO Immunization Unit was established in 1977, both PAHO and national program staff understood that the immunization cold chain was the dorsal column of the program.

To assure that vaccines provide the expected benefits when a patient receives an immunization, epidemiologist and health staff understand that each dose of vaccine administered has to be potent for protecting the recipient against the targeted disease(s). To achieve this objective the Immunization Unit, in PAHO, focused on five pillars:

advising countries to use good quality refrigeration equipment;
training of health staff in managing vaccines and their equipment;
carrying out evaluations on cold chain and supply chain operations;
carrying out research and development in the area of cold chain technology – both soft and hard;
improving management capacity and skills to support all operations related to the cold chain and supply chain, to introduce new vaccines.

Cold Chain resource center

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Evaluation

International evaluations of the Expanded Program on Immunization (EPI) have been conducted in the Americas since the 1980s, under the coordination and technical guidance of the Comprehensive Family Immunization Unit. While these evaluations focused specifically on the epidemiological surveillance system for measles in the 1990s, they were later expanded to cover all components of the EPI.

The purpose of the evaluation is to examine the EPI in the context of the health system and its broader surroundings. The evaluation looks at the program’s strengths and weaknesses, the efficiency and effectiveness of its activities and its impact on disease. It also assesses the program’s capacity to adapt to new demands, both those generated from health sector reform and decentralization, as well as those arising in response to the population’s need for access to new vaccines and technologies.

Methodology for International EPI Evaluations, 2014

Methodology for the Evaluation of Missed Opportunities for Vaccination, 2014

Technical Recommendations

The PAHO/WHO Technical Advisory Group on Vaccine-preventable Diseases (TAG) was formed in 1985 during the push to eradicate poliomyelitis from the Americas.

The TAG is made up of a group of experts in vaccines and immunization-related issues from the Region of the Americas. After each meeting, the TAG issues recommendations that provide technical guidance on the best strategies and tactics to achieve the overall goals of the Expanded Program on Immunization (EPI) in the Region.

Technical Advisory Group (TAG) on Vaccine-preventable Diseases

Caribbean EPI Managers Meeting Reports

WHO Vaccine Position Papers

Strategic Advisory Group of Experts on Immunization (SAGE)

Policy Documents

The technical and administrative policies of PAHO are established through meetings of the Organization’s Governing Bodies. Governing Bodies comprises the following: The Pan American Sanitary Conference, the Directing Council, and the Executive Committee. The auxiliary advisory body to the Executive Committee is the Subcommittee on Program, Budget, and Administration.

PAHO's Governing Bodies approved in September 2021, the resolution "Reinvigorating Immunization as a Public Good for Universal Health" to revitalize immunization programs in Member States through the application of innovative approaches and best practices.

In addition, the resolution provides an assessment of the current status of immunization programs in the Region, identifying key areas and challenges, and proposes priority lines of action based on a revitalized vision of immunization as a public good for universal health.

To achieve this vision in the Americas, the document proposes six lines of action:

Strengthen governance, leadership, and financing of immunization programs
Enhance monitoring of vaccine coverage and surveillance, incorporating digital intelligence strategies into routine analysis
Strengthen the integration of immunization programs into the primary health care system toward universal health
Develop innovative and strategic communication approaches to build social awareness and trust in vaccines and increase access to services
Strengthen human resource capacities for immunization programs
Use scientific evidence to guide decision making and program implementation

Reinvigorating Immunization as a Public Good for Universal Health

technical-document-reinvigorating-immunization

Technical document: CD59/10 - Reinvigorating Immunization as a Public Good for Universal Health
Resolution: CD59.R13 - Reinvigorating Immunization as a Public Good for Universal Health

Yearly Progress Reports of the Regional Immunization Action Plan (RIAP)

resolution-reinvigorating-immunization-as-a-public-good

2015-2020

Approved Plans of Action by Member States must present progress reports to member countries during the Directing Council. For the Immunization Plan of Action, several reports have been presented to PAHO's Governing Bodies.

CD54/7: Regional Immunization Action Plan (RIAP) 2015 - 2020
CD54.R8: Resolution on Immunization Action Plan
Progress report (Information until the end of 2015). Published in 2016
Midterm progress report (information until the end of 2016). Published in 2017
Progress report (Information until the end of 2017). Published in 2018
Progress report (Information until the end of 2018). Published in 2019
Progress report (Information until the end of 2019). Published in 2020
Final report (information until the end of 2020). Published in 2021

Immunization Agenda 2030

The World Health Assembly, with the support of countries and partners, has endorsed the Immunization Agenda 2030 (IA2030), a new global vision and strategy, to address challenges related to immunization over the next decade and save over 50 million lives.

IA2030 envisions a world where everyone, everywhere, at every age, fully benefits from vaccines to improve health and well-being. It aims to maintain hard-won gains in immunization, recover from the disruptions caused by COVID-19, and achieve even more – by leaving no one behind, in any situation or at any stage of life.

Visit the dedicated website for IA2030

Technical Resources

PAHO’s Immunization Unit and the WHO’s Department of Immunization, Vaccines and Biologicals have published numerous documents, training courses, guidelines and other resources to support the daily operations of national immunization programs.

Maternal and Neonatal Immunization: Field Guide (View / Download)
Introduction and Implementation of New Vaccines: Field Guide (View / Download)
Tailoring Immunization Programmes (View / Download)
Manual for Surveillance of Events Supposedly Attributable to Vaccination or Immunization in the Region of the Americas (View / Download)
Behavioural and social drivers of vaccination: tools and practical guidance for achieving high uptake (View / Download)
Crisis Communication related to vaccine safety: technical guidance (View / Download)
Tools for monitoring the coverage of integrated public health interventions. Vaccination and deworming of soil-transmitted helminthiasis (View / Download)
Electronic Immunization Registry: Practical Considerations for Planning, Development, Implementation and Evaluation (View / Download)

Diphtheria
Haemophilus influenzae type B
Hepatitis B
Control of diphtheria, pertussis, tetanus, haemophilus influenzae type B, and Hepatitis B: Field guide (View / Download)

Human Papillomavirus (HPV) Vaccine
Methodology to calculate HPV Vaccine Coverage in the Region of the Americas (View / Download)

Measles
Rubella
Regional Framework for the Monitoring and Re-Verification of Measles, Rubella, and Congenital Rubella Syndrome Elimination in the Americas (View / Download)
Measles and Rubella Risk Assessment Tool. User Guide (View / Download)

Poliomyelitis
Regional Plan for Containment of Poliovirus in the Americas. Regional-GAPIII (View / Download)

Pneumococcus
Meningococcus
Surveillance of Bacterial Pneumonia and Meningitis in Children Aged Under 5 years: Field Guide (View / Download)
Surveillance of Bacterial Pneumonia and Meningitis in Children Aged Under 5 Years: Field Guide. Second Edition (View / Download)

Rotavirus
Epidemiological Surveillance of Diarrheal Diseases Due to Rotavirus: Field Guide (View / Download)

Yellow fever
Control of yellow fever: Field guide (View / Download)
Viscerotropic Disease Associated with Yellow Fever: Case Studies. Guide for Facilitator (View / Download)
Viscerotropic Disease Associated with Yellow Fever: Case Studies. Guide for Participant (View / Download)

Immunization Newsletter

Immunization Job Aids

PAHO Articles in the Global Immunization Newsletter (GIN)

Training

Course: Tools for monitoring coverage of integrated public health interventions-2022

Course (WHO): Orientation to national deployment and vaccination planning for COVID-19 vaccines

Course: Surveillance of Events Supposedly Attributable to Vaccination or Immunization (ESAVI) - Available in Spanish

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Vaccine safety crisis communication course

Course: Crisis communication related to vaccine safety: technical guidance - Available in English, Spanish, French and Portuguese

Course: Measles Outbreak in the Post-Elimination Era - Case Study - Available in Spanish

Course: Rapid Response to Measles and Rubella Outbreaks in the Americas - Available in Spanish

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Course: Communication on vaccine safety: Guidance to support Health Care Workers - Available in English, Spanish, French and Portuguese

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Revolving Funds for Access to Vaccines

For more than 40 years, PAHO’s Revolving Fund for Access to Vaccines, has provided access to safe and quality vaccines at affordable prices for Member States and Territories throughout the region. It is part of Immunization's larger technical cooperation package that supports countries' efforts to achieve sustainable and equitable reduction of morbidity and mortality of vaccine-preventable diseases through control and elimination strategies. By consolidating forecasted demand requirements and leveraging economies of scale, promoting transparent negotiations with suppliers, and implementing innovative acquisition strategies, the Revolving Fund, greatly improves its purchasing power; lowering vaccine prices and contributing to the sustainability of National Immunization Programs.