[The expanded program of vaccination: 25 years tomorrow].

The expanded program on immunization will soon celebrate its 25th anniversary. The original program included vaccination against diphtheria, tetanus, pertussis, poliomyelitis, measles, and tuberculoses. It was expanded to include first yellow fever and hepatitis B and later haemophilus. Results are mixed. Diphtheria was under control but has made a major comeback since vaccination was halted in eastern Europe. Tetanus in newborns should no longer be a public health problem by 2005. Control of pertussis has not been achieved because the vaccine has been unsuccessful in interrupting transmission. Poliomyelitis is no longer reported in the Americas. Hopefully transmission of the wild virus will be stopped by 2003 and total eradication of poliomyelitis will be achieved by 2005. For several reasons, there has been an alarming increase in tuberculosis with an estimated annual incidence of 5 million cases worldwide. Eradication of measles was achieved in the Americas in 2000 and is expected in the European region by 2007 and in the east Mediterranean area by 2010. Current data on yellow fever and hepatitis B is inadequate, these vaccination being still poorly implemented in endemic areas. A more widespread use of the vaccine will be needed. However spending cutbacks and changing priorities in the Health Ministries will require a renewal of commitment to this immunization policy.