we reviewed all available vwa country reports to paho from 2004 to 2009 ( electronic and paper versions ) . each year after vwa , countries are asked to report disaggregated data , when available , related to the achievement of their preestablished vwa vaccination goals , to describe vaccination activities and other integrated public health activities and trainings carried out , to analyze defined indicators ( when applicable ) , and to report on resource mobilization , launching events , and communication efforts . each year a small percentage of countries do not submit reports and the completeness of the country reports submitted varies considerably . to fill information gaps , we used other sources of information , such as email , phone , and travel reports . we did not include data from 2003 , because this was the pilot year of vwa and limited information was available at paho . although vwa is officially only 1 week long , most countries extend their vaccination activities , particularly campaigns , over the course of several weeks . as a point of reference , we consolidated vwa vaccination and communication activities into broad categories and listed them by country per year ( supplementary tables 1 and 2 ) . to summarize the integration of other preventative health interventions with vaccination during vwa , we identified all other interventions implemented and grouped countries by intervention and year , listing target populations ( table 1 ) . the percentage of countries and territories participating in vwa has varied from a low of 40% ( 19 countries and territories ) in 2003 to a high of 96% ( 45 countries and territories ) in 2007 and 2008 . there are 47 countries and territories in the region of the americas : 35 countries , 6 uk overseas territories , 3 constituent countries of the kingdom of the netherlands , and 3 public bodies within the country of the netherlands . a wide range of vaccination activities have been implemented under the umbrella of vwa and include intensification of the routine program to complete vaccination schedules ; polio eradication campaigns for young children ; measles - rubella elimination campaigns ; vaccination against seasonal influenza , in the southern hemisphere ; tetanus - diphtheria vaccination , targeting women of childbearing age and young adults of both sexes ; campaigns targeting occupational risk groups such as healthcare workers , farmers , and fishermen ; introduction of new vaccines ; and information , education , and communication activities related to vaccination for healthcare workers and/or the general public , among others ( supplementary table 1 ) . eight lac countries have provided vitamin a supplements as a part of vwa ; 7 countries have done so for 3 years , and 2 countries have done so over the entire period examined . three countries have distributed deworming tablets for 1 year of vwa , and 2 have done so during the entire period examined . other integrated interventions included educational activities about health topics other than immunization ; supplementation with iron , folic acid , and other vitamins and minerals ; distribution of oral rehydration solution ; provision of health and dental care in remote areas ; identification of children not included in the civil registry of persons of one particular country ; promotion of eye tumor screening for children ; and other health screenings ( pap smears , hypertension , diabetes , and tuberculosis ) ( table 1 ) . although the number of vaccine doses and , in most cases , coverage data are available for most countries and territories participating in vwa , data on the results of integrated interventions are limited . vwa has been a successful initiative for lac countries to conduct supplementary immunization activities , target hard - to - reach groups , introduce new vaccines , and maintain immunization on the political agenda . although the integration of other preventative interventions with vwa was never put forth as part of the framework of this initiative at the regional level , it has become clear that many lac countries have chosen to take advantage of vwa as a platform for such activities . some countries have consistently integrated other preventative interventions with vwa , and others have done so more sporadically . it is likely that countries that regularly integrate interventions generally have closer coordination among health programs at the national level . other factors that probably affect sustained integration include whether the yearly calendar of activities in both health programs coincides and whether the program to be integrated has consistent funding . it has been discussed that linking another intervention to a strong immunization program has the possibility to quickly increase coverage and impact for the added intervention . for countries doing national vwa interventions and reporting coverage for both vaccination and integrated interventions , coverage seems to be high for both , and the targets are generally comparable . for example , during vwa 2009 , mexico reported national vaccination coverage ranging from 80.5% ( measles , mumps , rubella [ mmr ] vaccine dose to first - graders ) to 107% ( diphtheria , pertussis , tetanus , polio , haemophilus influenzae type b vaccine [ dapt+ipv+hib ] ) and coverage of both vitamin a supplementation and deworming treatment of 100% , based on their predefined target goals for each . in 2008 , nicaragua reported coverage ranging from 95% ( measles , rubella [ mr ] vaccine ) to 116% ( diphtheria , hepatitis b , haemophilus influenzae type b vaccine [ dtp - hepb - hib ] ) and coverage of vitamin a supplementation and deworming treatment at 96% and 90% , respectively . in our review , however , routine coverage levels did not seem to be a determining factor as to whether an lac country decided to integrate another intervention with immunization during vwa . countries with routine coverage of > 95% for several years , such as mexico , have routinely integrated other health interventions during vwa . however , haiti , the country with the lowest performance of all lac countries , having never reached coverage of > 70% , has integrated other services as well . it is not possible to assess the impact of the integration on vaccination coverage with the available data , but this is an important area for further investigation . it should be noted that the integration of other health interventions with routine vaccination services has occurred in several lac countries , predating the establishment of vwa . belize , bolivia , dominican republic , ecuador , el salvador , guatemala , haiti , honduras , mexico , nicaragua , panama , peru , and perhaps other countries have historically integrated the delivery of vitamin a supplementation into their routine vaccine delivery , as well as in other annual campaigns . in mexico , deworming efforts have been part of national health week since 1993 ; vwa occurs as part of the second national health week in this country each year . additionally , argentina , aruba , bahamas , barbados , bermuda , costa rica , cuba , dominica , dominican republic , el salvador , grenada , guyana , mexico , the former netherland antilles , nicaragua , panama , paraguay , peru , st kitts and nevis , st lucia , st vincent and the grenadines , and trinidad and tobago deliver a package of interventions , including immunization , as part of their school - based health programs , which are often integrated with oral health programs . nevertheless , a recent systematic review on integration of immunization with other interventions in the developing world identified only 1 published article that presented data from peru in a clinical trial integrating vitamin a supplementation into immunization services [ 14 , 17 ] . data from most of the integration activities in lac countries are only available at the national level . the potential to further evaluate and document the lessons learned from lac countries on the integration of other interventions with immunization is an important subject that remains to be explored . first , we are using secondary data to explore the extent of integration of other interventions with vaccination as part of vwa . although all participating countries are asked to annually report on a standardized list of items , including any integrated interventions that took place , the reporting of vwa results to paho varies widely by country in format , level of detail , and completeness . thus , some integrated activities that took place may inadvertently be excluded from this analysis . moreover , because vaccination has always been the primary focus of vwa , integrated interventions by countries are often described only superficially , without quantitative detail on coverage or other measures of impact . such irregularities in data restrict the ability to compare data across countries and over time . this review provides insight into the degree and type of integration that occurs during vwa in lac countries and suggests that lac countries are integrating other interventions with immunization to a much larger extent than was known internationally based on the peer - reviewed and gray literature . in 2010 and 2011 , even more countries , particularly in the english - speaking caribbean , integrated interventions during vwa efforts after informal encouragement by paho subregional offices . this summary of integration during vwa points to the need to promote better and more complete reporting of integrated activities and may serve as a baseline to plan for additional evaluations of integration practices in lac . supplementary materials consist of data provided by the author that are published to benefit the reader . the authors thank the immunization programs of all lac countries and territories for participating in vwa and sharing their data , as well as the paho immunization focal points in these countries . we acknowledge the unwavering dedication of the healthcare workers who provide immunization services and other interventions to the people of latin america and the caribbean . conflicts that the editors consider relevant to the content of the manuscript have been disclosed .
vaccination week in the americas ( vwa ) is an initiative of the countries and territories of the americas that works to advance equity and access to vaccination . 
 the initiative focuses on reaching populations with limited access to regular health services and promotes solidarity among countries . as the expanded program on immunization is one of the world s 
 best - established health programs , integrating other interventions with immunization services has been highly promoted . 
 using data available from the pan american health organization , we explored the extent of integration of other interventions with immunization in latin american and caribbean ( lac ) countries as part of vwa . 
 at least 14 countries or territories have integrated other interventions with immunization during vwa . 
 the most common integrated intervention is vitamin a supplementation , followed by deworming . 
 however , a variety of other interventions have been integrated , such as educational activities , supplementation with vitamins and minerals , and provision of health services . data on coverage of integrated interventions are limited . 
 integration of other interventions with immunization in lac countries is widespread , and its impact and lessons learned merit further examination .