TABLE 1 World Health Organization—Recommended EPI Schedule

EPI Contact

Age of Infant

Intervention

Proposed contacts for IPTi-SP

1

Birth

BCG, OPV (monovalent HBVat birth is recommended in areas where HBV seroprevalence is high and maternal-infant vertical transmission represents a public health problem)

 

2

6 weeks

DPT, HBVa, Hib conjugate, OPV

 

3

10 weeks

DPT, HBVa, Hib conjugate, OPV

+

4

14 weeks

DPT, HBVa, Hib conjugate, OPV

+

5

9 months b

Measles and vitamin A (yellow fever vaccine is recommended for infants living in highly endemic areas)

+

NOTE: BCG = Bacille Calmette Guerin vaccine against tuberculosis; DPT = diphtheria toxoid, whole-cell pertussis, and tetanus toxoid vaccine combination; HBV = hepatitis B vaccine; Hib = Haemophilus influenzae type b conjugate vaccine; OPV = oral polio vaccine. Currently, many countries in sub-Saharan Africa are using a “pentavalent vaccine” at 6, 10, and 14 weeks (contacts 2–4) that delivers DPT, HBV, and Hib in a single inoculation.

a An acceptable alternative regimen for HBV is to give monovalent HBV at birth and at 6 and 14 weeks. However, this somewhat logistically complicated schedule (because of the skipped HBV dose at 10 weeks of age) is becoming less common as tetravalent (DPT, HBV) and pentavalent (DPT, HBV, Hib) combination vaccines (which require only a single injection) are becoming ever more popular.

b 9–12 months in areas where measles in infants has become uncommon.

SOURCE: Aylward et al., 2004; WHO, 2004b.

Intermittent Preventive Treatment in Children and Seasonal Intermittent Preventive Treatment

Intermittent preventive treatment in children (IPTc) refers to the use of IPT in children up to 5 years of age (Chandramohan et al., 2007). Seasonal IPT (sIPT) is defined as the administration of IPT to infants or children for a limited calendar period that coincides with the intense but highly seasonal transmission of malaria in certain ecologies, as in parts of West Africa. In practical terms, IPTc and sIPT often coincide, as seen in several studies that have investigated the relatively short-term use of IPT in children up to 5 to10 years of age during periods of marked seasonal transmission (Cisse et al., 2006; Dicko et al., 2004).

Concern About a Possible Rebound Effect

Theoretically, by delaying the acquisition of natural immunity, administering anti-malarial drugs either continuously or intermittently might lead to a “rebound”—an increase in morbidity or mortality after treatment ends compared to a control group that had not received continuous chemoprophylaxis or intermittent therapy. The committee carefully addressed concerns about continuous chemoprophylaxis by reviewing pertinent literature. For intermittent therapy, we considered in detail, both published and unpublished evidence provided by the IPTi Consortium.



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