Current status
DPT3 immunization coverage, 2011
DPT comprises a series of immunizations to prevent diphtheria, pertussis and tetanus. To be fully immunized, children must receive three doses of the vaccine before their first birthday. Complete coverage with three doses of DPT (DPT3) is a valuable indicator of countries' performance of routine immunization and is often considered a useful indicator of access to basic services, including health services.
Basic immunization schedule recommended for all children by the WHO Expanded Programme on Immunization
| Antigen | Age of 1st Dose | Doses in Primary Series | Interval Between Doses | |||
|---|---|---|---|---|---|---|
| 1st to 2nd | 2nd to 3rd | 3rd to 4th | ||||
| BCG | As soon as possible after birth | 1 | ||||
| Hepatitis B | Option 1 | as soon as possible after birth ( <24h) | 3 | 4 weeks (min) with DTP1 | 4 weeks (min) with DTP3 | |
| Option 2 | as soon as possible after birth ( <24h) | 4 | 4 weeks (min) with DTP1 | 4 weeks (min) with DTP2 | 4 weeks (min),with DTP3 | |
| Polio | OPV | 6 weeks (birth in high-risk countries) | 3 | 4 weeks (min) with DTP2 | 4 weeks (min) with DTP3 | |
| IPV/OPV sequential | 8 weeks (IPV 1st) | 1-2 IPV, 2 OPV | 4-8 weeks | 4-8 weeks | 4-8 weeks | |
| IPV | 8 weeks | 3 | 4-8 weeks | 4-8 weeks | ||
| DTP | 6 weeks (min) | 3 | 4 weeks (min) - 8 weeks | 4 weeks (min) - 8 weeks | ||
| Haemophilus influenzae type b | 6 weeks (min) with DTP1, 24 months (max) | 3 | 4 weeks (min) with DTP2 | 4 weeks (min) with DTP3 | ||
| Pneumococcal (Conjugate) | 6 weeks (min) with DTP1 | 3 | 4 weeks (min) with DTP2 | 4 weeks (min) with DTP3 | ||
| Rotavirus | Rotarix | 6 weeks (min) with DTP1, 15 weeks (max) | 2 | 4 weeks (min) with DTP2, no later than 32 weeks of age | ||
| RotaTeq | 6 weeks (min) with DTP1, 15 weeks (max) | 3 | 4 weeks (min) - 10 weeks with DTP2 | 4 weeks (min) with DTP3, no later than 32 weeks of age | ||
| Measles | 9-15 months (6 months min) | 2 | 4 weeks (min) | |||
| HPV | Quadrivalent 9-13 years of age; Bivalent 10-13 years of age | 3 | Quadrivalent - 2 mos (min 4 wks), Bivalent - 1 mos (max 2.5 mos) | Quadrivalent - 4 mos (min 12 wks), Bivalent - 5 mos | ||
For a comprehensive summary of recommended routine immunizations for children, go to http://www.who.int/immunization/policy/Immunization_routine_table2.pdf
Of the world’s 22.4 million children not immunized with DPT3, 16.3 million (or 73%) live in 10 countries
Absolute numbers of unvaccinated infants are highest in the most populous developing countries, some of which enjoy fairly high rates of immunization coverage. Efforts to raise global immunization will need a strong focus on the countries where the highest numbers of unvaccinated children live – while also ensuring that the countries where children are most likely to miss out on immunization are not neglected in the search for greater global impact.
GIVS Progress
One of the goals set forth by the Global Immunization Vision and Strategy (GIVS) (2006-2015) is to increase national immunization coverage to at least 90% by 2010 and to sustain such levels through 2015. Of the 195 countries and territories for which estimates are made, more than three quarters either achieved coverage of at least 90% by DTP3 or MCV in 2010 or were on track to do so by 2015 (as estimated by UNICEF and WHO; see http://www.biomedcentral.com/1471-2458/11/806 for details). Moreover, most recent WHO and UNICEF estimates suggest that 131 of 195 countries or territories have attained at least 90 per cent coverage with DTP3 by the end of 2011. However, in 2010, global DTP3 and MCV coverage levels stood at 84 and 85 per cent, respectively. This suggests that some counties have not met the mid-term GIVS goal.
Indeed, a total of 45 countries have made either insufficient or no progress towards the GIVS goal as measured by DTP3 coverage. These 45 countries are home to nearly two thirds of the world’s surviving infants not vaccinated with DTP3. Most of them are classified as developing or least developed by the World Bank (41 countries); about half are located in Africa (22 countries) and more than half (28 countries) are among the 75 priority countries where more than 95% of all maternal and child deaths occur. Similar patterns are seen for MCV coverage.
These results suggest that the failure to achieve the GIVS goals is at least in part linked to larger systemic shortcomings. They also highlight the importance of a renewed focus on issues of equity in the global efforts to raise vaccination coverage levels.
Future directions
With renewed commitment, increases in routine coverage and the improved availability of new vaccines, great progress can be achieved in reducing child deaths, even in the poorest countries and under difficult circumstances. Strategies to reach every district include re-establishing outreach services, district level microplanning, providing supportive supervision and linking communities with services.
In addition, campaigns such as those for polio eradication and measles mortality reduction have helped strengthen the cold chain and injection safety. Support from the GAVI Alliance for the introduction of new vaccines, including training, demand creation and cold-chain expansion, help boost immunization activities.