Sunday, 20 January 2008
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POST 01217E: SCHOOL-BASED TT VACCINATION FOLLOW UP ON POSTS POST 01212E AND POST 01214E 20 JANUARY 2008 ------------------------------------------------------------------------------------- Robert Steinglass, who has comprehensively documented Indonesia’s experience with school-based TT immunization, spells out the programmatic and scientific rationale behind adopting this strategy. Incidentally, I hope most of you have responded to Jos Vandelaer’s request for information regarding school-based vaccination programmes in your country (POST 01214E) and will support WHO’s efforts to document country-specific experiences. ************************************************************** SCHOOL-BASED IMMUNIZATION: A PROMISING STRATEGY Thank you for stimulating interest among TECHNET readers in school-based approaches to sustain the elimination of tetanus and for Jos Vandelaer’s explanation of WHO's plans in this area. Tetanus toxoid immunization could be a cost-effective addition to an integrated, comprehensive package of school health services. Countries that have a high enrollment rate of girls in the early grades of primary school can take advantage of the long-lasting duration of immunity from each successive dose of tetanus toxoid and immunize both girls and boys in the early grades, before the girls start to drop out of school. This will protect school-age children from tetanus (due to injuries in sports or school gardens, for example), as well as increase the protection of girls as they enter their childbearing age. There are a number of countries (Bangladesh, Nepal, Uganda, Morocco, etc.) where over 85% of girls attend primary school. In one of several possible strategies (used in Indonesia and Nepal), for example, all children in the first few grades can be immunized during a single annual visit to each primary school. If a girl stays three years in school, she will receive three doses which, on top of the primary DTP series she received in infancy, will most likely protect her throughout her childbearing years. In the few high-risk countries where the enrollment rate of girls in secondary school is high, girls and boys could also be immunized during secondary school. The scientific and programmatic rationale for adopting school-based tetanus boosters is that it provides: Ø a long-lasting immunity against tetanus and diphtheria from each successive dose of toxoid; Ø an anamnestic response (immunological memory) to doses of toxoid received long ago; Ø an opportunity to take advantage of the high enrollment of girls in the early grades of primary school; Ø a means to "catch-up" on the immunization of children not reached during infancy (primes them and closes the immunity gap); Ø an extension of the duration of protection from earlier infant doses; Ø a reduction in the number of doses needed for females who are harder to reach as adults; Ø protection against neonatal tetanus for higher-risk first births (depending on total number of doses the female received); Ø sustainability for gains achieved during mass tetanus toxoid campaigns by channeling political interest into follow-up action; and Ø an ability to be efficiently integrated into a comprehensive package of school health interventions. School-based immunization is a promising strategy to reach children beyond the traditional target of infancy against tetanus and some other vaccine-preventable diseases in the future (e.g., HPV, typhoid). One drawback to early school-based vaccination has been that because it does not pay out dramatic and immediate dividends, most donors and MOHs have tended to avoid it as a strategic option. However, the long-term sustainable benefits of school-based vaccination in some countries — particularly when coupled with consistently high infant coverage and the relative ease of delivering an integrated package of school-based services — should make this an attractive option in those countries where female enrollment rates are high. Robert [[log in to unmask]] --------------------------------------------------------------------------------------- All members of the TechNet21 e-Forum are invited to send comments on any posting or to use the forum to raise a new discussion or request technical information in relation to immunization services. The comments made in this forum are the sole responsibility of the writers and do not in any way mean that they are endorsed by any of the organizations and agencies to which the authors may belong. Visit the TECHNET21 Website at http://www.technet21.org You will find instructions to subscribe, a direct access to archives, links to reference documents and other features. To UNSUBSCRIBE, send a message to : [log in to unmask]">[log in to unmask] Leave the subject area BLANK In the message body, write unsubscribe TECHNET21E The World Health Organization and UNICEF support TechNet21. 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