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Immunization in practice, a practical guide for health staff
  1. A Isaacs

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World Health Organisation, 2004, pp 230, €31. 13 (paperback book and CD-ROM), ISBN 92 4 154651 4

There have been some great successes in global immunisation in the last decade with the near eradication of polio and reductions in neonatal tetanus. In some developing countries childhood immunisation coverage is increasing, but in others it is still extremely low; for example, only 50% of infants in Sub-Saharan Africa compared to the United Nations goal of 90%. There is still great inequality between wealthy and low income countries in access to and delivery of safe vaccination. Thus there are millions of the most vulnerable children at risk of life threatening and disabling diseases.

The challenge of global immunisation

Leaving political and economic problems aside, how can immunisation rates in developing countries be improved and sustained? This book aims to provide a resource of practical and management skills to health workers in developing countries to reach this goal, and could equally be used as a training manual. It is the result of work between many organisations including the WHO, Children’s Vaccine Program, and UNICEF. It covers the common target diseases and their vaccines, and aims to promote the use of underused vaccines such as Hib, yellow fever, and hepatitis B. The immunisation schedule is based on the “Expanded Programme on Immunisation” and includes combination vaccines, for example, DTP-HepB + Hib. The book would need to be used in conjunction with up to date national policies and vaccine schedules, which vary between countries and are regularly changing as new vaccines are introduced. The book is divided into eight modules with summary tables to emphasise key points and clear diagrams. It covers the practical aspects of delivering effective immunisation in great detail, for example, the cold chain including details of transport and refrigeration. It explains how to make a homemade sharps container and how to dispose of them, from incineration to burying in a disposal pit. Information on the diseases, vaccines, and side effects is quite brief, but practical.

The module on holding an immunisation session emphasises safe practice to reduce needle stick injuries, including how to set up a clinic, injection techniques, and adopting autodisable syringes to prevent reuse. Strategies are listed to improve coverage by developing a district plan from fixed, outreach, and mobile clinics, estimating vaccine needs, and on building links with the local community. Further modules cover the monitoring and recording of data.

This book is designed for developing countries and would be less useful for health professionals in the UK. It does not cover many of the new vaccines used in the UK, for example, conjugated pneumococcal or meningococcal vaccines, which are not priorities in developing countries. However, the practical sections on holding an immunisation session set clear quality standards which should be adopted by any organisation delivering an immunisation clinic. Up to date information on the UK immunisation schedule can be found online in the “Green Book” and its updates at under the publications section. The full version of this book can be found online at Overall this book will be a valuable tool in the global challenge of delivering safe and effective immunisation to all children.