From 15 to 25 June 2018, WHO and the Ministry of Health and Quality of Life of Mauritius organised a comprehensive review of the immunisation programme. External partner organisations supporting the review included: UNICEF, Centers for Disease Control and Prevention (CDC) and NESI/University of Antwerp.
WHO recommends that periodic EPI programme reviews are conducted in member countries every 3 to 5 years to assess the strengths and weaknesses of the immunisation system and vaccine-preventable disease (VPD) surveillance at all levels, with the aim to provide evidence for the strategic directions and priority activities for the immunisation programme.
The specific objectives of the review included:
- To conduct a comprehensive assessment of the organisation and implementation of the EPI programme in Mauritius
- To assess the organisation and the implementation of VPD surveillance (with specific focus on Acute Flaccid Paralysis (AFP), measles and AEFI) including the current measles outbreak management at all levels in Mauritius
- To conduct an immunisation data quality review (verification)
- To assess the introduction of the Hexavalent vaccine (DTP-HepB-Hib-IPV)
The review period included a desk review, training, field work including data collection and data entry, report writing and debriefing to the Ministry of Health and Quality of Life. Teams collected data through key informant interviews, document reviews and observation of immunisation practices. In addition the role of private health facilities and community health workers in immunisation service delivery were assessed. All 5 regions of Mauritius, as well as Rodrigues were included in the review.
Mauritius has a well-functioning national immunisation programme, which is fully government funded. The programme currently provides 14 antigens in various combinations, resulting in sustaining the control of vaccine-preventable diseases, including maintaining polio free status and sustaining the elimination of maternal neonatal tetanus. The introduction of new vaccines has been done smoothly without disrupting routine immunisation sessions or challenging the cold chain capacity.
However, in recent years there is an observed decline in reported coverage, which could be due to denominator issues, requiring further investigations. The current measles outbreak might indicate immunity gaps especially at sub-national level among high risk groups.
In line with global and regional targets, the Ministry of Health and Quality of Life needs to sustain its efforts for AFP surveillance, in order to maintain its polio free status. Measles and AEFI surveillance need to be strengthened.
NESI staff participated actively in the entire review process and was field team lead for two regions, and conducted interviews at the National Cold Store, Procurement Unit and the Pharmacovigilance Unit.