National Immunization Program in Iran: whys and why nots.

The national immunization program of Iran has played an important role in achievements toward the control, elimination and eradication of some important infectious diseases. However, there are challenges regarding both diseases covered by the program and the type of vaccine or route of delivery, which are discussed in this Commentary. The current immunization program does not provide vaccines for rotavirus, Haemophilus influenzae type b (Hib), varicella, pneumococcal and influenza. There are also issues regarding use of oral poliovirus vaccine (OPV) instead of inactivated vaccine (IPV) and whole cell pertussis (wP) instead of acellular pertussis vaccine (aP). We have reviewed the evidence regarding these immunization issues; it seems that at least for rotavirus and Hib, there is sufficient evidence regarding the efficiency of vaccination in Iran. OPV is currently preferred because of the endemic situation of polio in Afghanistan and Pakistan (eastern neighbors) and considerations of efficiency. More data are needed for the analysis of policies on pneumococcal and influenza vaccines and aP vaccine.