Routine surveillance of the incidence of vaccine-preventable diseases has not proved sensitive enough to demonstrate the impact of the Expanded Programme on Immunization (EPI) in many countries. In order to document progress since the start of the EPI in 1979, data are needed for several years prior to that. In most developing countries these can be found only in major cities or large hospitals. Therefore a system of sentinel surveillance, the Local Area Monitoring Project (LAM), is being set up in selected institutions in the major cities of the developing world. The goal is to include the major city of each of the 25 largest developing countries, with a total population of 115 million. These 25 countries together account for 85% of all births in the developing world. In some cases the city was selected because it had an excellent municipal reporting system. For example, the Istanbul Health Office collects data from 169 hospitals, primary health centres, maternal and child health clinics and other institutions, and provides compiled municipal figures within six weeks. The trend of measles cases seen at the Children's Hospital exactly matches the trend for the city as a whole, indicating that for measles, at least, the Children's Hospital is an excellent sentinel site representative of the whole city. Manila has a hospital to which all cases of infectious disease are routinely referred, which is also a good sentinel site. In Rangoon it has been necessary to survey four hospitals, and in Jakarta seven, to cover all the target diseases.(ABSTRACT TRUNCATED AT 250 WORDS)
PIP: Routine surveillance of the incidence of vaccine-preventable diseases has not proved sensitive enough to demonstrate the impact of the Expanded Program on Immunization (EPI) in many countries. In order to document progress since the start of the EPI in 1979, data are needed for several years prior to that. In most developing countries these can be found only in major cities or large hospitals. Therefore a system of sentinel surveillance, the Local Area Monitoring Project (LAM), is being set up in selected institutions in the major cities of the developing world. The primary goal of the LAM project is to provide disease-incidence data of sufficient quality to evaluate more fully the global impact of the EPI on the 6 target diseases--diptheria, pertusis, tetanus, poliomyelitis, measles, and tuberculosis. The goal is to include the major city of each of the 25 largest developing countries, with a total population of 115 million. These 25 countries together account for 85% of all births in the developing world. The program and coverage information is used to assess the impact of individual EPI programs on disease trends. Preliminary analysis of the 12 cities with the best data suggests that the impact of the EPI on the incidence of the target diseases has been greater than previously shown by the routine system. The LAM information is useful for global and regional analysis of program impact, but for the countries themselves its utility may be even greater. It is hoped that the project will help to improve a country's surveillance system by encouraging the use of sentinel reporting as a means of supplementing routine data. The information on the impact of the EPI may further increase political and public support for a program.