As a large proportion of the target children were to be vaccinated at private schools, awareness activities were especially organized at these schools

10 March 2021 – Pakistan’s largest province Punjab and Islamabad completed the first phase of the typhoid conjugate vaccine (TCV) campaign in 12 out of the 24 districts of Punjab on 15 February 2021. More than 13 million children between 9 months and 15 years of age were vaccinated over 2 weeks. The federal and provincial government, in close collaboration with WHO and partners, organized the campaign in 12 districts of Punjab that marks the formal introduction of typhoid conjugate vaccine in routine immunization schedule of the Expanded Programme on Immunization (EPI) in this province.

Typhoid commonly affects children in low-resource communities causing serious illnesses and spreads through contaminated water, poor sanitation, and lack of food safety measures. Back in 2016, an extensive drug-resistant (XDR) strain was reported in Pakistan which infected more than 12 000 people in Sindh province. Children under 15 years were reported to be the most badly affected. By 2017, about 63% of Pakistan’s total cases and 70% of all typhoid-related deaths were among children under 15 years. In response to the XDR outbreak, a mass campaign was conducted in Sindh province followed by the introduction of TCV into the routine immunization programme where more than 10 million children were vaccinated in November 2019.

Typhoid fever is an important public health problem in many low and middle-income countries. It is most commonly caused by contaminated drinking water, poor sanitation and lack of food safety measures

“WHO has supported the Government of Pakistan since the first outbreak was reported. WHO experts contributed to strategic planning, microplanning, training, monitoring, and data analysis for evidence-based decision-making. Introduction of the TCV in Sindh resulted in the reduction of the XDR cases by two thirds. Pakistan has shown great commitment towards combating the XDR outbreak and implementing high-quality vaccination campaigns,” says Dr Palitha Mahipala, WHO Representative in Pakistan.

As Punjab comprises 53% of the country’s population, starting the campaign initially in 12 districts enabled Punjab to launch the campaign at a relatively smaller scale, giving the opportunity to focus on the quality of the campaign. The success of efforts to contain outbreaks rests on the consistent quality of campaigns and immunization service delivery to urban and rural areas. Lesson learnt in this phase will be incorporated in the next phase of the campaign which will start in May 2021 in all 24 districts of Punjab.

The launch of a vaccination campaign for 13 million children in Punjab and Islamabad and its simultaneous introduction into routine immunization has nevertheless been a daunting task, especially during the COVID-19 pandemic. The schools in Punjab and Islamabad re-opened after the prolonged break and allowed close to 3.5 million children (30% of total) to be vaccinated in schools and over 9 million children were vaccinated at home. A special focus was given to micro-planning, coordination and social mobilization to ensure that all children were reached. The provincial and federal governments and partners closely worked together to implement a high-quality campaign as per the new guidelines and procedures to keep staff, children and parents safe.

Equally, swift response mechanisms were put in place for any adverse events after immunization (AEFI). WHO has trained 700 AEFI focal persons and doctors, providing AEFI kits with essential medicines and supplies to deal with any emergency. Only 222 AEFI cases were reported highlighting the quality of the campaign and engagement with parents and caregivers on the possible slight side-effects of the vaccine.

These activities were supported by Gavi, the Vaccine Alliance.

Members of WHO team monitored the campaign through real-time online monitoring mobile application. The team members directly visited houses to collect the status of vaccination on ground. All the issues reported from field were addressed there and then through this application..

Ensuring good planning for the teams going door-to-door was essential to ensure all eligible children were reached during the campaign

 

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