Design of immunization programmes for developing countries

Factors to be considered in designing immunization programs in developing countries are summarized. The limiting factors will usually be costs of vaccines, administration equipment and supplies, transport and maintenance of the cold chain. Choices have to be made about the source of vaccines, whether produced locally or imported, size of vaccine lots and type of package, and quality control of vaccines. Selection of vaccines is treated in a separate appendix, but generally 3 groups are recognized: 1) recommended for general use: smallpox, diphtheria, tetanus, pertussis, BCG, typhoid and measles; 2) recommended for special cases: polio and yellow fever; 3) not recommended for developing countries: rubella, mumps, influenza, cholera; and 4) vaccines in development stage only: arbovirus, rickettsia, trachoma, meningococci, plague and shigella. Schedules for vaccine administration are suggested, such as plans for vaccination every 2 years, plans for 4 courses of vaccinations including 1 at school entry, and special programs such as smallpox campaigns and immunization of adolescent girls and fertile women with tetanus vaccine. Finally the importance of recording of vaccinees and assessment of programs is discussed.