COVID-19 in pediatrics in Latin America: six years later

COVID-19 has led to disruption in routine immunization programs around the globe and here in Canada. The National Advisory Committee on Immunization (NACI) in Canada has indicated that this sets the stage for serious outbreaks of vaccine-preventable diseases. The World Health Organization has evidence-based guidance on how to address missed opportunities for vaccination, albeit predominately applicable for low- and middle-income countries. In Canada, immunization applies beyond infant and childhood immunization, with immunization across the life course being recommended by NACI. Three components stand out and must be integrated and used concurrently for best effect on catch-up in Canada: (1) Identify who has been missed across the life course; (2) detect delivery gaps, adapt and adjust, and develop multipronged tailored strategies for catch-up; and (3) communicate, document, evaluate and readjust the immunization programs. All must be adapted to the reality of the evolving COVID-19 pandemic. We cannot go back to a pre-COVID-19 world. However, ensuring that routine immunization and catch-up programs are done well during this pandemic strengthens the immunization foundation in Canada for when COVID-19 vaccines become available.

Hydro-meteorological and geological disasters can pose serious harm to community health, such as an increased risk of infectious diseases and related mortality. We conducted a scoping review to compile the available literature on the effects of hydro-meteorological and geological disasters on routine immunisation and vaccine-preventable disease (VPD) outbreaks among children and adolescents under 18 years. We searched Medline, Embase, Global Health, Scopus, and Web of Science for original studies and systematic reviews on the topic published by the 21st of October 2024. We included studies that quantitatively analysed the effect of any of the thirty Emergency Events Database (EM-DAT) recognised hydro-meteorological and geological disasters (or those fitting EM-DAT criteria) on a comprehensive list of World Health Organization (WHO)-recommended vaccines and the 23 diseases against which they prevent. We included 26 studies, of which 19 concerned with vaccine-preventable disease outbreaks and seven focused on routine immunisation disruption.. Our review indicates that floods, cyclones, droughts, extreme temperatures, tsunamis, and earthquakes may result in vaccine-preventable disease outbreaks and routine immunisation disruption, and identified young children and refugees as at-risk populations. Flooding was reported to be associated with water-borne and vector-borne vaccine-preventable disease outbreaks such as malaria. Poor water, sanitation and hygiene (WASH) were further recognised as facilitating conditions for vaccine-preventable disease outbreaks after disasters. The vaccination studies reported reduction in routine immunisation rates in the months following a disaster, considering infrastructural damage to health facilities and vaccine storage issues as common causes. Finally, there was significant knowledge gap on the effects of specific disasters (e.g., wildfires and volcanic eruptions) and diseases (e.g., influenza, yellow fever, malaria, and dengue).In conclusion, our review reinforce the need for better policies to ensure vaccine equity, resilient health system and safe WASH to prevent vaccine-preventable disease (VPD) outbreaks following hydro-meteorological and geological disasters.

Implications of the COVID-19 pandemic for both populations and healthcare systems are vast. In addition to morbidity and mortality from COVID-19, the pandemic also disrupted local health systems, including reductions or delays in routine vaccination services and catch-up vaccination campaigns. These disruptions could lead to outbreaks of other infectious diseases that result in an additional burden of disease and strain on the healthcare system. We evaluated the impact of the COVID-19 pandemic on Zambia’s routine childhood immunization program in 2020 using multiple sources of data. We relied on administrative vaccination data and Zambia’s 2018 Demographic and Health Survey to project national disruptions to district-specific routine childhood vaccination coverage within the pandemic year 2020. Next, we leveraged a 2016 population-based serological survey to predict age-specific measles seroprevalence and assessed the impact of changes in vaccination coverage on measles outbreak risk in each district. We found minor disruptions to routine administration of measles-rubella and pentavalent vaccines in 2020. This was in part due to Zambia’s Child Health Week held in June of 2020 which helped to reach children missed during the first six months of the year. We estimated that the two-month delay in a measles-rubella vaccination campaign, originally planned for September of 2020 but conducted in November of 2020 as a result of the pandemic, had little impact on modeled district-specific measles outbreak risks. This study estimated minimal increases in the number of children missed by vaccination services in Zambia during 2020. However, the ongoing SARS-CoV-2 transmission since our analysis concluded means efforts to maintain routine immunization services and minimize the risk of measles outbreaks will continue to be critical. The methodological framework developed in this analysis relied on routinely collected data to estimate disruptions of the COVID-19 pandemic to national routine vaccination program performance and its impact on children missed at the subnational level can be deployed in other countries or for other vaccines.

Implications of the COVID-19 pandemic for both populations and healthcare systems are vast. In addition to morbidity and mortality from COVID-19, the pandemic also disrupted local health systems, including reductions or delays in routine vaccination services and catch-up vaccination campaigns. These disruptions could lead to outbreaks of other infectious diseases that result in an additional burden of disease and strain on the healthcare system. We evaluated the impact of the COVID-19 pandemic on Zambia's routine childhood immunization program in 2020 using multiple sources of data. We relied on administrative vaccination data and Zambia's 2018 Demographic and Health Survey to project national disruptions to district-specific routine childhood vaccination coverage within the pandemic year 2020. Next, we leveraged a 2016 population-based serological survey to predict age-specific measles seroprevalence and assessed the impact of changes in vaccination coverage on measles outbreak risk in each district. We found minor disruptions to routine administration of measles-rubella and pentavalent vaccines in 2020. This was in part due to Zambia's Child Health Week held in June of 2020 which helped to reach children missed during the first six months of the year. We estimated that the two-month delay in a measles-rubella vaccination campaign, originally planned for September of 2020 but conducted in November of 2020 as a result of the pandemic, had little impact on modeled district-specific measles outbreak risks. This study estimated minimal increases in the number of children missed by vaccination services in Zambia during 2020. However, the ongoing SARS-CoV-2 transmission since our analysis concluded means efforts to maintain routine immunization services and minimize the risk of measles outbreaks will continue to be critical. The methodological framework developed in this analysis relied on routinely collected data to estimate disruptions of the COVID-19 pandemic to national routine vaccination program performance and its impact on children missed at the subnational level can be deployed in other countries or for other vaccines.

This study aimed to evaluate the impact of the COVID-19 pandemic on routine immunization (RI) programs in six northern Nigerian states: Bauchi, Borno, Kaduna, Kano, Sokoto, and Yobe. This was a cross-sectional analytical study that compared programmatic data from 2019 and 2020, as well as survey data collected during the pandemic. RI program variables included service delivery, leadership and governance, monitoring and evaluation/supportive supervision, community engagement, vaccine supply chains, and health finance and management. Data were analyzed using SPSS (version 23, IBM), Student’s t-test, and structural equation modeling. The results showed that RI programs were affected by the pandemic in terms of reduced meetings and low completion rates for action points in certain states. However, routine immunization support services increased owing to improved monitoring techniques and consistent vaccine deliveries, with fewer reports of stockouts. The most significant impact of the pandemic was observed on activities coordinated at the healthcare facility level, whereas those at the state level were less impacted. The major challenges encountered during the pandemic included insufficient supplies and consumables, movement restrictions, shortages of human resources, and fear of infection. In building a more resilient health system, governments and non-state actors will need to invest in strengthening delivery mechanisms at the core implementation level with a focus on facilities and communities.

The COVID-19 pandemic has put immense pressure on countries’ health structures to maintain routine immunization and VPD surveillance programs, especially in LMICs such as Bangladesh. Understanding the effects of COVID-19 will allow countries like Bangladesh to become better prepared for future health emergencies, so this study explored the effects of COVID-19 on routine immunization and VPD surveillance programs in Bangladesh. With a sequential mixed-method approach, the quantitative data was collected from the DHIS2 for January 2019-December 2021. The qualitative data was collected from ten KIIs, which was conducted with the key stakeholders of EPI and VPD surveillance in Bangladesh. Findings suggest that there had been three drop-rebound periods in the routine immunization program in Bangladesh. The study identified that Bangladesh was able to catch up with the pre-pandemic level immunization within four to six months from the first drop, and the immunization drops became less severe with the progression of time. COVID-19-related movement restrictions, lack of workforce, fear and concern regarding COVID-19, prioritizing COVID-19 vaccination, lack of a comprehensive EPI structure in urban compared to rural areas, and lack of knowledge to conduct EPI and VPD activities amidst the pandemic situation were identified as the main reasons for these drops.

The COVID-19 pandemic has put immense pressure on countries' health structures to maintain routine immunization and VPD surveillance programs, especially in LMICs such as Bangladesh. Understanding the effects of COVID-19 will allow countries like Bangladesh to become better prepared for future health emergencies, so this study explored the effects of COVID-19 on routine immunization and VPD surveillance programs in Bangladesh. With a sequential mixed-method approach, the quantitative data was collected from the DHIS2 for January 2019-December 2021. The qualitative data was collected from ten KIIs, which was conducted with the key stakeholders of EPI and VPD surveillance in Bangladesh. Findings suggest that there had been three drop-rebound periods in the routine immunization program in Bangladesh. The study identified that Bangladesh was able to catch up with the pre-pandemic level immunization within four to six months from the first drop, and the immunization drops became less severe with the progression of time. COVID-19-related movement restrictions, lack of workforce, fear and concern regarding COVID-19, prioritizing COVID-19 vaccination, lack of a comprehensive EPI structure in urban compared to rural areas, and lack of knowledge to conduct EPI and VPD activities amidst the pandemic situation were identified as the main reasons for these drops.

BackgroundA novel meningococcal serogroup A conjugate vaccine (MACV [MenAfriVac]) was developed as part of efforts to prevent frequent meningitis outbreaks in the African meningitis belt. The MACV was first used widely and with great success, beginning in December 2010, during initial deployment in Burkina Faso, Mali, and Niger. Since then, MACV rollout has continued in other countries in the meningitis belt through mass preventive campaigns and, more recently, introduction into routine childhood immunization programs associated with extended catch-up vaccinations.MethodsWe reviewed country reports on MACV campaigns and routine immunization data reported to the World Health Organization (WHO) Regional Office for Africa from 2010 to 2018, as well as country plans for MACV introduction into routine immunization programs.ResultsBy the end of 2018, 304 894 726 persons in 22 of 26 meningitis belt countries had received MACV through mass preventive campaigns targeting individuals aged 1–29 years. Eight of these countries have introduced MACV into their national routine immunization programs, including 7 with catch-up vaccinations for birth cohorts born after the initial rollout. The Central African Republic introduced MACV into its routine immunization program immediately after the mass 1- to 29-year-old vaccinations in 2017 so no catch-up was needed.ConclusionsFrom 2010 to 2018, successful rollout of MACV has been recorded in 22 countries through mass preventive campaigns followed by introduction into routine immunization programs in 8 of these countries. Efforts continue to complete MACV introduction in the remaining meningitis belt countries to ensure long-term herd protection.

Continuity of routine immunization programs in Canada during the COVID-19 pandemic

Polio eradication: getting the basics right

What is already known about this topic?The World Health Organization (WHO) varicella vaccines position paper states that countries where varicella is an important public health burden could consider introducing varicella vaccine (VarV) in the routine childhood immunization program (1). VarV has been available for many years in China but is not included in most routine immunization programs in China. As a result, substantial heterogeneity in vaccination coverage exists across regions. What is added by this report?In Beijing, adding a second dose of VarV for children and increasing coverage reduced the incidence of varicella. Lowering the age of the first dose of VarV to 12 months could further reduce varicella, especially among toddlers.What are the implications for public health practice?Governments should use economic analysis to consider inclusion of VarV into the routine children immunization program as a free vaccine and adopting a 2-dose schedule that starts at 12 months of age.

BackgroundThe introduction of the COVID-19 vaccine influenced discussions to explore integrating COVID-19 vaccination into routine immunization (RI) programs. Subsequently, the WHO Strategic Advisory Group Experts (SAGE) on immunization plausibly advised countries to leverage the COVID-19 vaccination rollout as a transformative opportunity to establish a resilient immunization system, through an integrated immunization system, resulting in strengthened primary healthcare services.ObjectiveThis study assessed the enablers and barriers to integrating COVID-19 vaccination into the routine immunization programme in Ekiti state, Nigeria.MethodsThis study utilized a qualitative research approach to obtain information from 40 participants selected purposively across the primary healthcare facilities, LGA, and state levels. A three-tier approach was employed to select the LGAs. At the same time, In-depth interviews were conducted to elicit relevant information on the assessment of enablers and barriers to integrating COVID-19 vaccination into routine immunization through an interview guide. All the audio interview files were transcribed into English Language, coded, and presented using a thematic approach.ResultsA total of 40 healthcare workers across Ekiti state were selected to participate in this study. Our study found the enablers of integrating COVID-19 into routine immunization to include demand generation and social mobilization, health education, health workers training, data validation, financing, and supervision. However, rumors, demand for incentives, Adverse Events Following Immunization (AEFI), manpower shortage, poor internet network services, and bad road networks were reported as barriers to integrating COVID-19 vaccination into routine immunization in Ekiti state.ConclusionWhile the enablers of integrating COVID-19 vaccination into routine immunization may outweigh its barriers, it is pertinent to know that the efforts towards integrating COVID–19 vaccination in the RI Program is a call to all stakeholders to ensure sustainability. The identified barriers in the study must be addressed to ensure a strengthened health system. Therefore, achieving a successful integration and uptake of vaccination/immunization is anchored on driving demand generation, social mobilization, health education, availability of healthcare workers, integrated supervision, and financing.

A practical approach to immunization in atopic children.

ObjectivesTo evaluate the cost effectiveness of the use of nine-valent pneumococcal polysaccharide conjugate vaccine in a routine infant immunisation programme based on the Pneumococcal Vaccine Trial (PVT) study in The Gambia.MethodsThis was a clinical trial-based cost-effectiveness study conducted as part of the PVT study. The PVT was an intention-to-treat double-blind placebo-controlled trial of a nine-valent pneumococcal polysaccharide conjugate vaccine. The trial was conducted in the eastern parts of The Gambia, West Africa and recruited 17 437 children aged 40–364 days. A deterministic static cohort model was developed to evaluate direct benefits and costs of pneumococcal conjugate vaccine in The Gambia's routine immunisation programme. The incremental cost-effectiveness ratio (iCER) is defined as vaccinating infants against pneumococcal disease compared with no vaccination from a public provider's perspective using The Gambia's 2005 projected under-one-year population.Key findingsThe results show the use of the vaccine in The Gambia's routine infant vaccination programme to be cost effective using an assumed price of US$5.00 per vial in single-dose vials. Compared with offering no vaccination, the incremental cost per DALYs averted would be 30 DALYs from the public provider perspective. At least 1569 and 340 invasive childhood pneumococcal illnesses and deaths respectively among the cohort would be prevented. In the absence of the vaccine 16 871 DALYs would be lost while with the use of the vaccine 7804 DALYs would be lost. Given the average treatment cost of pneumococcal illnesses to be US$191 (95% confidence interval 180 to 203) the introduction of the vaccine programme would lead to an additional cost of US$274 279 (about US$8.43/child).ConclusionsThe availability of a cost-effective vaccine that can prevent thousands of pneumococcal illnesses and related deaths is a major development towards improving the disease burden in sub-Saharan African countries. This study supports the introduction of nine-valent pneumococcal vaccine into the infant immunisation programme of The Gambia as it is cost effective and will avert many preventable deaths and illnesses. Despite differences in distribution of serotypes between countries, the static model used in the analysis makes the results applicable to other developing countries, particularly those in sub-Saharan Africa.

BackgroundThe COVID-19 pandemic disrupted essential health care services globally, including routine childhood immunization programs. Ecuador faced significant challenges in maintaining vaccination coverage during this period.ObjectiveThe aim of this study is to analyze the impact of the COVID-19 pandemic on routine childhood vaccination coverage in Ecuador by comparing prepandemic (2019) and pandemic (2020‐2021) data.MethodsThis retrospective observational study analyzed vaccination coverage data from the Ministry of Public Health of Ecuador and demographic data from the National Institute of Statistics and Censuses. We examined routine childhood vaccination coverage for children under 24 months across all 24 provinces. Statistical analyses were performed using SPSS (version 28.0), including descriptive statistics and comparative analysis. Coverage rates were calculated as percentages of children in target age groups receiving recommended doses.ResultsA significant decline in routine childhood vaccination coverage was observed during the pandemic. BCG vaccine coverage decreased from 86.4% in 2019 (n=286,569) to 80.7% in 2020 (n=266,961) and 75.3% in 2021 (n=248,812). Pentavalent vaccine third dose coverage dropped from 85.0% to 68.0% across the same period. The most dramatic decline was seen in measles-mumps-rubella vaccine second dose coverage, falling from 75.7% in 2019 to 58.4% in 2021. Coastal and highland provinces experienced the most severe reductions, with approximately 137,000 fewer doses administered in 2020 compared to stable prepandemic levels.ConclusionsThe COVID-19 pandemic significantly impacted routine childhood vaccination coverage in Ecuador, with sustained declines through 2021. Regional disparities were evident, with vulnerable populations facing greater challenges accessing immunization services. Urgent interventions, including catch-up campaigns and strengthened health systems, are needed to restore coverage levels and prevent outbreaks of vaccine-preventable diseases.