October 2003

Like its predecessor, "EPI Essentials" (1988), this manual has been written for immunisation programme managers at national and sub-national levels in developing countries and for people who support these managers, particularly field staff of donor agencies. The intention is to provide information that is practical as well as technically and operationally sound. For readers who would like to explore topics in greater depth, additional references are provided.

In revising "EPI Essentials", the authors have tried to listen to readers' feedback, which was generally positive. Users appreciated having such a variety of practical information in one compact volume; the user-friendly format with many photos, forms, tables, and quotations; the accessible writing style; and, at times, the authors' provocative attitude.

USAID decided to revise the earlier volume because it had long been out of print and because, over the past 15 years, immunisation programmes have undergone a number of significant changes. These include new objectives(e.g., accelerated disease control for polio, measles, and neonatal tetanus), new vaccines (e.g., hepatitis B and Hib), new procedures to solve old problems (e.g., injection safety), new technologies for vaccine delivery and coldchain, and health sector reforms. Such changes underscore the need for constant attention, sharing of experience, creativity, and flexibility in respondingto problems.

A central theme is that there is not just one way of doing things. This manual provides managers and other decision-makers with scientifically based principles, policies, and standards; technical specifications for vaccines and equipment; and operational considerations that they must weigh to devise the best solutions for their circumstances. Examples in the manual draw on real life experiences to illustrate how technical and operational issues can be addressed in the field.

In addition to technical changes, immunisation has been subject to boom and bust funding cycles, which are mirrored in fluctuations in coverage rates and disease transmission. USAID sees a need to use the boom times to build strong managerial capacity, stable funding commitments, and a wide base of support for the task required to be done year after year for the foreseeable future to protect every child in every country.

USAID views the provision of a primary series of vaccines in the first year of life (often called "routine immunisation") as the cornerstone of all immunisation efforts and other primary health care efforts as well. The fact that immunisation gives each child five contacts with the health system before the age of one year is a tremendous opportunity that is often underutilised. While the necessity for "routine immunisation" for every birth cohort remains constant, immunisation programmes are anything but static. Decentralisation, integration, and other changes in primary health service delivery pose a continual challenge, and public health personnel must be ever vigilant to make sure that the tremendous promise of immunisation is sustained.

Table of Contents

• Preface
• Acknowledgements
• Acronyms
• Introduction
• Immunization Program Management
• Delivery of Immunization Services
• Monitoring, Evaluation, and Information Management
• Vaccine Supply and Quality
• The Cold Chain and Logistics
• Injection Safety
• Disease Surveillance
• The Role of Behavior Change
• Costs and Financing
• New Vaccines and Technologies
• Vaccines and Vaccine-Preventable Diseases

Chapters 3, 4 and 9 in particular have a focus on communication and change.

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