Kenya EPI updates, 2011

1. KenyaEPI updates, 2011 Dr Collins Tabu,Division of Vaccines and Immunization, KNH Research Symposium, 3rd June, 2011

2. Presentation Outline • Introduction • Immunization status, Kenya • Key milestones in Kenya EPI, 2010/2011 • Kenya EPI’s gaps and challenges • Interventions/ way forward

3. Introduction 1/2 • EPI, currently rebranded as Division of Vaccines and Immunization (DVI) started as a unit within the Ministry of Health 1980 • Goal was to immunize all children in the country against the six traditional EPI diseases • 22 years later in 2002, Pentavalent vaccine (DPT-HepB-Hib) introduced into EPI • In January 2011, Pneumococcal vaccine (PCV 10) introduced into EPI with GAVI support, ceremonial launch 14th Feb 2011

4. Introduction 2/2 • In addition, DVI now provides the following non-EPI vaccines • Yellow fever for travelers, Rabies, Anti snake venom, Typhoid vaccine, & Hepatitis B for health workers (initiated this year) • Current DVI Focus • Reducing dropout rates • Replacing old/ worn out equipment • Introduction of new vaccines – Hepatitis B for health workers • Typhoid vaccination for special groups • Supplementary Immunization activities- Polio, Measles

5. Kenya, facts and figures

6. Immunization coverage by antigen and year, 2001-2010 Census (New Denominator)

7. Immunization coverage by antigen and Province 2010

8. Key mile-stones 2010/2011

9. 1. PCV 10 Introduction • Introduced Nationwide, January 2011 • Decision to introduce PCV 10 informed by studies on burden of invasive pneumococcal disease in Kenya- NetSPEAR, Pneumo-ADIP, KEMRI/CDC, KEMRI Wellcome Trust • Objective to reduce child mortality & facilitate attainment of MDG 4 • GoK to fund the vaccine through co-financing of the vaccine cost for the period of support • Teams formed to cover the following tasks: • Vaccine procurement & Distribution • Cold chain assessment • Revision of EPI reporting tools • Training of HCWs on management of the vaccine • Advocacy & social mobilization for the introduction • Monitoring and evaluation- PIE, AEFI

10. PCV 10 Introduction National coordinating structure National Steering Committee Technical Working Group (TWG) Logistics Sub-Committee Training Sub-Committee Advocacy, Communication & Social Mobilization Sub-Committee Monitoring & Evaluation Sub-Committee

11. PCV 10 Launch, Kenya, Feb 2011

12. PCV 10 Introduction, Challenges and Opportunities Challenges Opportunities Resource mobilization for new vaccine introduction High demand for the vaccine – real danger of stock outs Community perceptions on multiple antigen vaccinations Real opportunity to achieve MDG 4 Renewed govt, partners & community interest in immunization Training opportunity for Health workers Created momentum for GAPP implementation

13. 2. Cold chain inventory • Done at all immunizing health facilities and storage points • Confirmed final information on Cold Chain capacity and additional requirements to make an informed re-distribution and replacement plan of cold chain equipment • Conforms to pneumococcal vaccine storage requirements? • Completed, awaiting report finalization

14. 3. Community Knowledge Attitudes & Practices baseline survey • Commissioned to inform communication strategy and training materials development • Key objectives explored: • Practices and behaviour towards pneumonia and underlying determinants • Information channels & interpersonal networks by which caregivers learn about and develop attitudes towards health services and vaccination • Levels of credibility or trust for common information sources

15. 4. PCV 10 Catch-up campaign • Accelerated immunization of the 12-59 month children in 2 districts- Rarieda & Kilifi to allow them ‘catch up’ with the <1 yr olds receiving routine immunization, in order to form a cohort of immune individuals • Objectives: • To allow rapid evaluation of indirect effects of PCV10 herd-protection following immunization and serotype replacement diseases • To bring forward an assessment of population effectiveness of immunization with PCV10 • To monitor the impact of pneumococcal vaccine effectiveness on invasive pneumococcal disease and radiologically confirmed pneumonia

16. 5. Others • Programmatic monitoringto: • Assess impact of the PCV 10 introduction training • Identify potential problems in new vaccine management, handling and administration • Document changes in the EPI system as a result of new vaccine introduction • Adverse events following immunization (AEFI) study ongoing in 3 demographic surveillance sites in the country with special focus on: • Injection site abscesses within 7 days of vaccination • Shock within 48 hours of vaccination (TSS?) • Death within 7 days of vaccination

17. Gaps & challenges

18. Immunization Program gaps • Funding for Routine Immunization activities • Introduction of new vaccines and ongoing measles outbreaks among migrant communities and threats of polio and yellow fever importation • Vaccine stock management • Data quality assessment • Capacity building of health workers on immunization • Advocacy on immunization

19. Current Interventions/ Way forward

20. Current Interventions Integration of immunization services with other child survival interventions (CSIs) using the RED approach as its implementation framework Broadening community awareness, participation and ownership and BCC to influence caregiver KAPs to immunization and other CSIs Integrating immunization services into the broader health system strengthening agenda Fostering partnership for immunization and advocating for increased immunization financing Overhaul and modernization of the country’s cold chain Introduction of the Rota Virus Vaccine 2013

21. Thank you