40th Anniversary of Introduction of Expanded Immunization Program (EPI): A Literature Review of Introduction of New Vaccines for Routine Childhood Immunization in Sub-Saharan Africa

A systematic review including a grey literature search was conducted to identify papers reporting about the introduction of new vaccines in the routine immunization programs of SSA countries. Different databases (PubMed, ISI Knowledge Center, and AIM) and records from WHO, UNICEF, MoH, NGO and other agencies working on immunization were searched by using keywords and were limited to the articles or reports published in the last five years. Inclusion and exclusion criteria were applied to find the most relevant articles or reports for this review. The search yielded 1087 papers dating from May 31 st May 2009 to May 31 st 2014of which 44 (4%) were found to be relevant and included in the review analysis. We found that half the number of deaths in children under the age of five worldwide due to new VPDs is derived from the region of SSA. However, in the recent decade, and with the support of the several donors, the majority of SSA countries have made remarkable progress in introducing new vaccines into their NIP. HepB and HibCV vaccines have been added to all the immunization programsof48 countries. The introduction of PCV and rotavirus vaccines has reached 66% and 41% of countries respectively. PCV-13 and monovalent rotavirus vaccines are the ones most widely used in immunization programs across SSA countries. For HPV vaccination Rwanda and South Africa completed the roll-out at national level through a schoolgirl based approach, and several other countries in SSA have started HPV demonstration projects. The implementation of school based vaccination programs in SSA countries given still lower school enrolment and attendance constitutes however a challenge. The WHO recommended immunization schedule of 6, 10, 14weeks for infant vaccinations has been adopted by majority of SSA countries. The routine administration of birth dose monovalent HepB vaccine is currently only given in seven countries in SSA and poses a challenge as many home deliveries still occur in SSA limited access for skilled health-care providers at the time of childbirth.