2-dose Vaccination Coverage Research Articles

Pediatric Rash Illness Outbreak with Initial Positive Measles Immunoglobulin M Antibody Test Results - American Samoa, March-July 2023.

On April 24, 2023, the American Samoa Department of Health (ASDoH) declared a public health emergency amid concern about a possible measles outbreak given low 2-dose vaccination coverage at the time. ASDoH had received two positive measles immunoglobulin (Ig) M test results after Flag Day festivities 1 week earlier from vaccinated children. ASDoH performed active case finding, took actions to mitigate transmission, and requested technical assistance from CDC. ASDoH implemented a vaccination campaign to improve suboptimal coverage. Confirmatory molecular testing of specimens from these initial persons under investigation (PUIs) was not possible, but subsequent testing of specimens from additional PUIs by Hawaii State Laboratories Division and CDC ruled out measles. In settings with low measles prevalence, measles antibody testing results have low positive predictive value and can lead to difficulties with interpreting results. Testing for additional pathogens revealed a variety of viruses known to cause common childhood viral exanthems. Both molecular and serologic testing should be performed for all suspected measles cases. To decrease the probability of false-positive IgM results, testing should be reserved for cases that meet the Council of State and Territorial Epidemiologists measles case definition, especially those in persons with no evidence of immunity and with a history of recent international travel. In addition, maintaining high measles vaccination coverage can prevent future outbreaks.

Population-level impact of switching to 1-dose human papillomavirus vaccination in high-income countries: examining uncertainties using mathematical modeling.

A concern in high-income countries is that switching to 1-dose human papillomavirus (HPV) vaccination could cause a rebound in HPV infection and cervical cancer if 1-dose efficacy or duration were inferior to 2 doses. Using mathematical modeling and up-to-date trial-based data, we projected the population-level effectiveness of switching from 2-dose to 1-dose vaccination under different vaccine efficacy and duration assumptions in high-income countries. We used HPV-ADVISE (Agent-based Dynamic model for VaccInation and Screening Evaluation), a transmission-dynamic model of HPV infection and cervical cancer, varying key model assumptions to identify those with the greatest impact on projections of HPV-16 and cervical cancer incidence over time: 1) 1-dose vaccine efficacy and vaccine duration, 2) mechanisms of vaccine efficacy and duration over time, 3) midadult (>30 years of age) sexual behavior, 4) progression to cervical cancer among midadults, and 5) vaccination coverage and programs. In high-income countries, 1-dose vaccination would cause no appreciable rebound in HPV-16 infection, except for a limited rebound under the most pessimistic assumptions of vaccine duration (average, 25 years), because 1) the switch would occur when HPV prevalence is low because of high 2-dose vaccination coverage and 2) individuals would be protected during their peak ages of sexual activity (<35 to 40 years of age). Our model projects a more limited rebound in cervical cancer because of a shift to older age at infection, resulting in fewer life-years left to potentially develop cancer. Projections were robust when varying key model assumptions. High protection during peak ages of sexual activity in high-income countries would likely mitigate any potential rebounds in HPV infection and cervical cancer under the most pessimistic assumptions of 1-dose efficacy and duration.

Sociodemographic Inequalities in COVID-19 Booster Dose Vaccination Coverage: a Retrospective Study of 196 Provinces in Peru.

The COVID-19 vaccination coverage shows variability in booster doses between residency areas or ethnicity. The aim of this study was to evaluate how sociodemographic conditions influence unequal vaccination coverage with booster doses against COVID-19 in Peru. A retrospective, ecological study with an evaluation of 196 provinces in Peru. The sociodemographic conditions were evaluated as sources of inequality (sex, age group, educational level, residence area, and ethnic group). The inequality measure used was the GINI, an index that show the inequal vaccination coverage with third and fourth booster doses against COVID-19 in Peruvians provinces. The index allow determinate a higher inequality when the value is near to 1, and a lower inequality when the value is near to 0. Also, the impact of each sociodemographic condition in the general inequality was evaluate with a decomposition analysis of GINI coefficient into Sk (composition effect), Gk (redistribution effect), Rk (differential effect). In provinces evaluated the mean vaccine coverage for the third and fourth booster doses was 57.00% and 22.19%, respectively at twelve months since the beginning of vaccination campaign. The GINI coefficient was 0.33 and 0.31, for the third and fourth booster doses coverage, respectively. In the decomposition analysis, twelve months after the start of the third and fourth dose vaccination campaign, revealed higher Sk values for people living in rural areas (Sk = 0.94 vs. Sk = 2.39, respectively for third and fourth dose), while higher Gk values for Aymara (Gk = 0.92 vs. Gk = 0.92, respectively), Quechua (Gk = 0.53 vs. Gk = 0.53, respectively), and Afro-Peruvians (Gk = 0.61 vs. Gk = 0.61, respectively). Also, higher negative correlation in Rk values for people with elementary education (Rk=-0.43 vs. Rk=-0.33, respectively), aged between 15 and 19 years (Rk=-0.49 vs. Rk=-0.37, respectively), and Aymara (Rk=-0.51 vs. Rk=-0.66, respectively). The rural residency area, lower education and Quechua, Aymara or Afro-Peruvians ethnicity determinated inequalities in vaccination coverage with booster doses against COVID-19 in Peruvian provinces.

Status of hepatitis B birth dose vaccination coverage in Vietnam during 2020 - 2022

A descriptive cross-sectional study in 63 provinces/cities in Vietnam during 2020 - 2022 was conducted to describe the current status of hepatitis B birth dose vaccination in Vietnam. The results showed that the proportion of hepatitis B birth dose (HepB-BD) vaccination in this period was 83.2%, of which the proportion of HepB-BD vaccination within 24 hours and after 24 hours of birth was 78.9% and 4.3% respectively. For socio-economic regions, the highest proportion of HepB-BD vaccination was 90.9% in the Red River Delta and the lowest was 72.3% in the Central Highlands. The proportion of HepB-BD vaccination within 24 hours was less than 70.0% in Central Highlands during 2020 - 2022. The proportion of HepB-BD vaccination in Vietnam in the period 2020 - 2022 was high, with uneven changes between years and socio-economic regions. It is necessary to increase the proportion of HepB-BD vaccination, especially within 24 hours after birth.

Effectiveness of BNT162b2 and Sinovac vaccines against the transmission of SARS-CoV-2 during Omicron-predominance in Hong Kong: A retrospective cohort study of COVID-19 cases.

In 2022, SARS-CoV-2 Omicron variants circulated globally, generating concerns about increased transmissibility and immune escape. Hong Kong, having an infection-naive population with a moderate 2-dose vaccine coverage (63% by the end of 2021), experienced a COVID-19 epidemic largely seeded by Omicron BA.2 variants that led to the greatest outbreak in the region to date. Little remains known about the protection of commonly-administered vaccines against transmission of Omicron BA.2 variants. In this retrospective cohort study, we identified 17 535 laboratory-confirmed COVID-19 cases using contact tracing information during the Omicron-predominant period between January and June 2022 in Hong Kong. Demographic characteristics, time from positive test result to case reporting, isolation, or hospital admission, as well as contact tracing history and contact setting were extracted. Transmission pairs were reconstructed through suspected epidemiological links according to contact tracing history, and the number of secondary cases was determined for each index case as a measurement for risk of transmission. The effectiveness of mRNA vaccine (BNT162b2) and inactivated vaccine (Sinovac) against transmission of BA.2 variants was estimated using zero-inflated negative binomial regression models. Vaccine effectiveness against transmission for patients who received the 2-dose BNT162b2 vaccine was estimated at 56.2% (95% CI: 14.5, 77.6), 30.6% (95% CI: 13.0, 44.6), and 21.3% (95% CI: 2.9, 36.2) on 15 - 90, 91 - 180, and 181 - 270 days after vaccination, respectively, showing a significant decrease over time. For 3-dose vaccines, vaccine effectiveness estimates were 41.0% (95% CI: 11.3, 60.7) and 41.9% (95% CI: 6.1, 64.0) on 15 - 180 days after booster doses of Sinovac and BNT162b2, respectively. Although significant vaccine effectiveness was detected in household settings, no evidence of such protective association was detected in non-household settings for either Sinovac or BNT162b2. Moderate and significant protection against Omicron BA.2 variants' transmission was found for 2 and 3 doses of Sinovac or BNT162b2 vaccines. Although protection by 2-dose BNT162b2 may evidently wane with time, protection could be restored by the booster dose. Here, we highlight the importance of continuously evaluating vaccine effectiveness against transmission for emerging SARS-CoV-2 variants.

Case study of a 2022 pertussis epidemic in the Baoro sub-prefecture (Central African Republic)

ObjectiveThe objective of this survey was to describe epidemiological characteristics and evaluate vaccine effectiveness against pertussis in the sub-prefecture of Baoro (Central African Republic). MethodWe conducted a case control study from June to July 2022 in the sub-prefecture of Baoro in the district of Baour-Baoro. Community-based definitions of surveillance were applied to include cases and controls. ResultsAll in all, 143 confirmed and suspected cases and 166 controls were enrolled in this investigation. The epidemic had affected 12 neighborhoods and 9 villages. The village of Bugbassem alone had 32 patients, and 50% of the patients lived in rural areas. The age groups of 12 to 59 months accounted for 58% of cases. Patients were female in 54% of cases (p = 0.8). The attack rate among unvaccinated patients (65%) was higher than that of vaccinated patients (40%), while 15% (N = 21) of children were hospitalized with no recorded deaths. Pentavalent 3rd dose vaccination coverage was 49% in controls versus 33% in cases. Vaccination provided a significant protective effect (Odds Ratio = 0.3; 95% CI: 0.2–0.6). All told, vaccine efficacy against pertussis was 38%. ConclusionPertussis is a re-emerging disease currently occurring as a result of low pertussis vaccination coverage. It strongly affects rural areas with low vaccination rates. Vaccination strategy requires reinforcement in rural areas.

Hepatitis B vaccine delivered by microneedle patch: Immunogenicity in mice and rhesus macaques.

Vaccination against hepatitis B using a dissolving microneedle patch (dMNP) could increase access to the birth dose by reducing expertise needed for vaccine administration, refrigerated storage, and safe disposal of biohazardous sharps waste. In this study, we developed a dMNP to administer hepatitis B surface antigen (HBsAg) adjuvant-free monovalent vaccine (AFV) at doses of 5µg, 10µg, and 20µg, and compared its immunogenicity to vaccination with 10µg of standard monovalent HBsAg delivered by intramuscular (IM) injection either in an AFV format or as aluminum-adjuvanted vaccine (AAV). Vaccination was performed on a three dose schedule of 0, 3, and 9weeks in mice and 0, 4, and 24weeks in rhesus macaques. Vaccination by dMNP induced protective levels of anti-HBs antibody responses (≥10 mIU/ml) in mice and rhesus macaques at all three HBsAg doses studied. HBsAg delivered by dMNP induced higher anti-HBsAg antibody (anti-HBs) responses than the 10µg IM AFV, but lower responses than 10µg IM AAV, in mice and rhesus macaques. HBsAg-specific CD4+ and CD8+ T cell responses were detected in all vaccine groups. Furthermore, we analyzed differential gene expression profiles related to each vaccine delivery group and found that tissue stress, T cell receptor signaling, and NFκB signaling pathways were activated in all groups. These results suggest that HBsAg delivered by dMNP, IM AFV, and IM AAV have similar signaling pathways to induce innate and adaptive immune responses. We further demonstrated that dMNP was stable at room temperature (20°C-25°C) for 6months, maintaining 67±6 % HBsAg potency. This study provides evidence that delivery of 10µg (birth dose) AFV by dMNP induced protective levels of antibody responses in mice and rhesus macaques. The dMNPs developed in this study could be used to improve hepatitis B birth dose vaccination coverage levels in resource limited regions to achieve and maintain hepatitis B elimination.

Minority Health Social Vulnerability Index and COVID-19 vaccination coverage - The United States, December 14, 2020-January 31, 2022.

In 2021, HHS Office of Minority Health and CDC developed a composite measure of social vulnerability called the Minority Health Social Vulnerability Index (MHSVI) to assess the needs of communities most vulnerable to COVID-19. The MHSVI extends the CDC Social Vulnerability Index with two new themes on healthcare access and medical vulnerability. This analysis examines COVID-19 vaccination coverage by social vulnerability using the MHSVI. County-level COVID-19 vaccine administration data among persons aged ≥18 years reported to CDC from 12/14/20 to 01/31/22 were analyzed. U.S. counties from 50 states and DC were categorized into tertiles of vulnerability (low, moderate, and high) for the composite MHSVI measure and each of the 34 indicators. Vaccination coverage (≥1 dose, primary series completion, and receipt of a booster dose) was calculated by tertiles for the composite MHSVI measure and each indicator. Counties with lower per capita income, higher proportion of individuals with no high school diploma, living below poverty, ≥65 years of age, with a disability, and in mobile homes had lower vaccination uptake. However, counties with larger proportions of racial/ethnic minorities and individuals speaking English less than "very well" had higher coverage. Counties with fewer primary care physicians and greater medical vulnerabilities had lower ≥ 1 dose vaccination coverage. Furthermore, counties of high vulnerability had lower primary series completion and receipt of a booster dose. There were no clear patterns in COVID-19 vaccination coverage by tertiles for the composite measure. Results from the new components in the MHSVI identify needs to prioritize persons in counties with greater medical vulnerabilities and limited access to health care, who are at greater risk for adverse COVID-19 outcomes. Findings suggest that using a composite measure to characterize social vulnerability might mask disparities in COVID-19 vaccination uptake that would have otherwise been observed using specific indicators.

COVID-19 Booster Dose Vaccination Coverage and Factors Associated with Booster Vaccination among Adults, United States, March 2022

The Centers for Disease Control and Prevention recommends a COVID-19 vaccine booster dose for all persons >18 years of age. We analyzed data from the National Immunization Survey-Adult COVID Module collected during February 27-March 26, 2022 to assess COVID-19 booster dose vaccination coverage among adults. We used multivariable logistic regression analysis to assess factors associated with vaccination. COVID-19 booster dose coverage among fully vaccinated adults increased from 25.7% in November 2021 to 63.4% in March 2022. Coverage was lower among non-Hispanic Black (52.7%), and Hispanic (55.5%) than non-Hispanic White adults (67.7%). Coverage was 67.4% among essential healthcare personnel, 62.2% among adults who had a disability, and 69.9% among adults who had medical conditions. Booster dose coverage was not optimal, and disparities by race/ethnicity and other factors are apparent in coverage uptake. Tailored strategies are needed to educate the public and reduce disparities in COVID-19 vaccination coverage.

Uptake of Heterologous or Homologous COVID-19 Booster Dose and Related Adverse Events Among Diabetic Patients: A Multicenter Cross-Sectional Study - China, 2022.

Although a third coronavirus disease 2019 (COVID-19) vaccination (booster) dose is highly recommended for diabetic patients, the vaccination behaviors and related adverse events are unclear among diabetic patients with a COVID-19 booster dose. Diabetic patients with higher postprandial blood glucose, worrying about the safety of the booster dose were less likely to get the vaccine. While having positive attitudes towards COVID-19 booster vaccination, trusting the health professionals' advice on vaccination, diabetic patients were more likely to get the booster vaccine. Furthermore, the prevalence of adverse events was not significantly different between the homologous and heterologous boosting groups. Effective measures should be taken to promote the COVID-19 booster dose uptake among diabetic patients. Health professionals should educate Chinese diabetic patients about the safety and efficacy of booster doses and continue to increase the COVID-19 booster dose vaccination coverage.

A Dynamic Compartmental Model to Explore the Optimal Strategy of Varicella Vaccination: An Epidemiological Study in Jiangsu Province, China.

Varicella (chickenpox) is highly contagious among children and frequently breaks out in schools. In this study, we developed a dynamic compartment model to explore the optimal schedule for varicella vaccination in Jiangsu Province, China. A susceptible-infected-recovered (SIR) model was proposed to simulate the transmission of varicella in different age groups. The basic reproduction number was computed by the kinetic model, and the impact of three prevention factors was assessed through the global sensitivity analysis. Finally, the effect of various vaccination scenarios was qualitatively evaluated by numerical simulation. The estimated basic reproduction number was 1.831 ± 0.078, and the greatest contributor was the 5-10 year-old group (0.747 ± 0.042, 40.80%). Sensitivity analysis indicated that there was a strong negative correlation between the second dose vaccination coverage rate and basic reproduction number. In addition, we qualitatively found that the incidence would significantly decrease as the second dose vaccine coverage expands. The results suggest that two-dose varicella vaccination should be mandatory, and the optimal age of second dose vaccination is the 5-10 year-old group. Optimal vaccination time, wide vaccine coverage along with other measures, could enhance the effectiveness of prevention and control of varicella in China.

Influenza and COVID-19 Vaccination Coverage Among Health Care Personnel - United States, 2021-22.

The Advisory Committee on Immunization Practices (ACIP) and CDC recommend that all health care personnel (HCP) receive annual influenza vaccination to reduce influenza-related morbidity and mortality among these personnel and their patients (1). ACIP also recommends that all persons aged ≥6 months, including HCP, be vaccinated with COVID-19 vaccines and remain up to date (2,3). During March 29-April 19, 2022, CDC conducted an opt-in Internet panel survey of 3,618 U.S. HCP to estimate influenza vaccination coverage during the 2021-22 influenza season as well as receipt of the primary COVID-19 vaccination series and a booster dose. Influenza vaccination coverage was 79.9% during the 2021-22 season, and 87.3% of HCP reported having completed the primary COVID-19 vaccination series; among these HCP, 67.1% reported receiving a COVID-19 booster dose. Among HCP, influenza, COVID-19 primary series, and COVID-19 booster dose vaccination coverage were lowest among assistants and aides, those working in long-term care (LTC) or home health care settings, and those whose employer neither required nor recommended the vaccines. Overall, employer requirements for influenza and COVID-19 primary series vaccines were reported by 43.9% and 59.9% of HCP, respectively; among HCP who completed the primary series of COVID-19 vaccines, 23.5% reported employer requirements for COVID-19 booster vaccines. Vaccination coverage for all three vaccine measures was higher among HCP who reported employer vaccination requirements and ranged from 95.8% to 97.3% for influenza, 90.2% to 95.1% for COVID-19 primary series, and 76.4% to 87.8% for COVID-19 booster vaccinations among HCP who completed the primary series of COVID-19 vaccines, by work setting. Implementing workplace strategies demonstrated to improve vaccination coverage among HCP, including vaccination requirements or active promotion of vaccination, can increase influenza and COVID-19 vaccination coverage among HCP and reduce influenza and COVID-19-related morbidity and mortality among HCP and their patients (4).

Less than one-fifth of Ethiopian children were vaccinated for measles second dose; evidence from the Ethiopian mini demographic and health survey 2019

Ethiopia introduced the measles second dose vaccine from the routine expanded immunization program in 2018. Shreds of evidence are scarce on the measles second dose vaccination coverage and its associated factors in Ethiopia. We aimed to assess the measles second dose vaccination coverage and associated factors in Ethiopia using the recent Ethiopian Mini Demographic and Health Survey (EMDHS) 2019 data. An in-depth secondary data analysis was conducted based on the Ethiopian mini demographic and health survey 2019 data; which was a cross-sectional survey targeted on key indicators of maternal and child health. A weighted sample of 965 children was included in the analysis. A multi-level mixed effect logistics regression model was fitted. Adjusted Odds Ratio (AOR) with 95 %CI was reported for statistically significant variables. The measles second dose coverage was 12.36 % (95 %CI = 10.89, 15.44). Not vaccinated for the third dose of pentavalent vaccine (Penta 3) (AOR = 0.60, 95 %CI: 0.37, 0.95), age of the child [13 to 23 months (AOR = 2.14, 95 %CI: 1.05, 4.36), 24 to 36 months (AOR = 2.58, 95 %CI: 1.32, 5.05)], household head educational status [no education (AOR = 0.51,95 %CI: 0.26, 0.99), primary (AOR = 0.44, 95 %CI: 0.23, 0.85)], and living in south nation, nationalities and peoples region (SNNPR) (AOR = 2.83,95 %CI: 1.12, 7.11) were significantly associated with measles second dose vaccination coverage. Measles second dose vaccination coverage was low in Ethiopia. Age of the child, being vaccinated for the Penta 3, educational status of the household head, and region of residence were significant determinants of measles second dose vaccination coverage.

COVID-19 orphans-Global patterns associated with the hidden pandemic.

Whilst the COVID-19 pandemic has caused significant mortality across the globe, many children have been orphaned due to the loss of their parents. Using the framework of an ecological analysis, we used estimates of total maternal/paternal orphans using an online COVID-19 orphanhood calculator to estimate the total orphans per COVID-19 death for 139 countries. Descriptive statistics were used to determine global patterns behind this risk of children being orphaned. Linear regression models were fitted to determine factors associated with this risk, and the association with vaccination coverage was calculated. We found that there is tremendous global variation in the risk that COVID-19 deaths will lead to orphaned children, and that this risk is higher in countries below median GDP per capita (1·56 orphans per deaths) compared to countries above (0·09 orphans per death). Poverty prevalence (B = 2·32, p<0·01), GDP per capita (B = -0·23, p<0·05), and a greater proportion of people with NCDs being reproductive aged (B = 1·46, p<0·0001) were associated with this risk. There was a negative correlation between 2nd dose vaccination coverage and orphans per death (p<0·05). The risk of children being orphaned per COVID-19 death, alongside fertility rate, is due to there being a greater share of COVID-19 deaths among younger persons. This is more likely in poorer countries and those where the age distribution for non-communicable diseases that elevate COVID-19 mortality risk are more uniform. Due to vaccine coverage inequity, more children will suffer the loss of their parents in poorer countries.

Mask Compliance Modeling Related COVID-19 in Indonesia Using Spline Nonparametric Regression

Until now, Coronavirus disease (COVID-19) has become a concern for Indonesia because of its significant development and impact on various sectors of life and hampering the target of achieving Sustainable Development Goals (SDGs). The achievements targeted in the SDGs, such as reducing poverty, hunger, and many more are very difficult to realize in the current pandemic conditions. The uncertain conditions of the pandemic made the government need some new ideas for consideration in creating policies to encourage sustainable development in this situation. This article covers modeling the effect of achieving the second dose of vaccination and the total cases of COVID-19 cases, which are often considered the reason for general negligence in complying with health protocols, especially wearing masks. This research was conducted using spline nonparametric regression because of its flexibility to handle uncertain data patterns. The results of this study are truncated spline nonparametric regression with 3 knots that produce a R-sq equal to 69.952%. Based on the results, the second dose vaccination coverage variables and the total COVID-19 cases together affect mask compliance. This result is expected to be a benchmark for the government to handle COVID-19 and efforts to achieve the SDGs.

The impact of the acceleration of COVID-19 vaccine deployment in two border regions in Oman

BackgroundAmong the challenges to public health systems imposed by coronavirus disease 2019 (COVID-19) have been vaccine scarcity and the prioritization of high-risk groups. Countries have been prompted to accelerate the pace of immunization campaigns against COVID-19 to deploy the immunization umbrella to the largest possible number of target groups. In this paper, we share the perspective of Oman regarding the impact of accelerating the administration of the first dose of the COVID-19 vaccine in one border governorate (Musandam) by comparison to another border governorate (Al-Buraimi) where this approach was not applied. MethodsDaily admissions data (April 10, 2020 to June 24, 2021) and vaccination data (January 1 to June 24, 2021) were collected systematically. For each governorate, the cumulative doses (first and second doses) and vaccination coverage were calculated daily. ResultsWithin 1 month, first dose vaccination coverage increased from 20% to 58% in Musandam, reducing the incidence of hospital admission by 75%. In comparison, vaccination coverage plateaued at 20% in Al-Buraimi, and the incidence of hospital admission increased by 500%. ConclusionsGiven the peculiarity of the geographical location and being the first line of access for imported cases, border regions should be a priority for vaccine deployment as a preventive measure. The two different approaches reported here, implemented in broadly similar cross-border governorates, provide evidence of the significant effect of accelerating the first dose of vaccine in reducing hospitalizations.

Hepatitis B birth dose vaccination for newborns in Uganda: A qualitative inquiry on pregnant women's perceptions, barriers and preferences

BackgroundSub-Saharan Africa continues with very low hepatitis B (HBV) birth dose vaccination coverage. To guide policy on HBV vaccine for newborns, we explored perceptions, barriers and preferences of pregnant women regarding HBV and the HBV birth dose vaccination MethodsWe conducted eight focus groups discussions (FGDs) among 70 pregnant women, stratified by rural-urban residence, age and education level, using a structured focus group discussion guide to explore birth dose awareness, perceptions, barriers and preferences. Data were transcribed, coded and analysed using framework analysis. ResultsPerceptions related to HBV and liver cancer causes and prevention were diverse; most FGD participants did not perceive illnesses as distinctly different. Older women-groups, both urban and rural, had never heard about HBV, but were aware of liver cancer, viewing the disease as fatal. No FGD participants were aware of HBV birth dose. Concerns included vaccine safety, its availability to women who deliver outside the health system and mistrust in health-care worker (HCWs) when handling newborns. Rural-dwelling groups perceived absence of HBV services, while FGDs with young participants believed vaccine side-effects hampered birth dose planning. Most women-groups preferred (i) oral to injectable vaccines; (ii) receiving birth dose education during antenatal, to media-based education; (iii) that newborns receive the birth dose immediately after delivery in the mother's presence. ConclusionAlthough the birth dose is acceptable among pregnant women, planners need to continuously engage them as key stakeholders during planning to address concerns, in order to raise confidence, maximize uptake and strengthen HBV eradication efforts.

Hepatitis B birth dose vaccination patterns in the Military Health System, 2014–2018

BackgroundSince 2005, the universal hepatitis B (HepB) birth dose has been recommended for all medically stable infants weighing ≥2,000 g at birth. The timing of the birth dose provides a critical safeguard and prevents infection among infants born to HBsAg-positive mothers not identified prenatally. We assess infant HepB vaccination in the U.S. Department of Defense’s Military Health System (MHS) to identify trends in vaccination coverage and sociodemographic factors associated with non-receipt of the birth dose, receiving the first HepB vaccine >3 days of life, and not receiving any HepB vaccine in the first 18 months of life utilizing parental refusal codes. To our knowledge, this is one of the first studies assessing trends in parental refusal of the HepB birth dose utilizing administrative claims parental refusal codes. MethodsWe conducted a retrospective cohort analysis of MHS live births from January 1, 2014 through December 31, 2018 utilizing administrative claims data. Data were included from 44 hospitals in 24 unique states, territories, or countries. We analyzed diagnosis codes for vaccine refusal and vaccination and current procedural terminology (CPT) codes to identify vaccination patterns. Generalized linear mixed effects models with a logit link were used to assess factors associated with vaccination patterns. ResultsHepB birth dose vaccination coverage increased from 79.6% in 2014 to 88.1% in 2018 (p < .0001). Refusal rates also increased from 3.7% in 2014 to 4.5% in 2018 (p < .0001). The percentage of patients with missing diagnosis codes for vaccine refusal or vaccination decreased from 16.7% in 2014 to 7.4% in 2018. Factors associated with non-receipt of the birth dose included earlier year of birth, white maternal race, higher maternal age, higher birth order, and longer infant length of stay in hospital. ConclusionVaccination coverage for HepB birth dose is high in the MHS and increased over time; concurrently, refusal rates also increased over time. Utilizing administrative claims data has the benefit of differentiating reasons for non-receipt of the birth dose over time.

Measles virus circulation between the State members of the Indian Ocean Commission?

Background: Despite the availability of safe and effective vaccines, measles resurgence has been observed worldwide in 2018 and 2019. In West Indian Ocean (WIO), almost all islands have reported measles cases during these years. Vaccine coverage was particularly low in Madagascar and Comoros Island, with a single dose provided by the Expanded Program on Immunization. Because of intense exchanges between WIO islands, outbreaks observed in WIO were probably related. Methods and materials: Thanks to the Epidemic Intelligence Unit and the SEGA-One Health network of the Indian Ocean Commission (IOC), composed of five countries (Comoros, Madagascar, Mauritius, France (Reunion), and Seychelles), epidemiological data from each surveillance system were shared. Results: Measles outbreaks have successively occurred in: Mauritius (W12/2018), Madagascar (W35/2018), Reunion (W51/2018) and Comoros (W21/2019; first cases were reported early 2019). As of W41/2019, Madagascar was the most affected island with 244 557 cases (attack rate around 929/100 000) and a case fatality rate of 0,4%. Attack rate was lower in Mauritius (117/100 000) were 1 482 and 4 deaths were reported. In Reunion and Comoros, respectively 96 and 132 cases (of whom 62 were confirmed) were reported; no deaths were reported. Two measles genotypes were circulating in the region: genotype B3 in Madagascar and Comoros; genotype D8 in Mauritius; in Reunion Island both genotypes were observed. Only one case was reported in December 2018 in Seychelles were 2-dose vaccine coverage reached 99% in 2017. Conclusion: Given starting date of each outbreak and circulating genotypes, it can be assumed that outbreaks were closely related, measles virus circulating especially between Mauritius and Reunion on the one hand, and between Madagascar, Comoros and Reunion on the other hand. WIO islands are considered as an epidemiological block where pathogens easily circulate through human and animal exchanges. This situation underlines the importance of the SEGA network which should be further strengthened. For example, development of biological cooperation between WIO islands could help comprehensive epidemiological analyses in the course of outbreaks.

Measles and rubella IgG seroprevalence in persons 6 month-35 years of age, Mongolia, 2016

BackgroundIn 2015–2016, Mongolia experienced an unexpected large measles outbreak affecting mostly young children and adults. After two nationwide vaccination campaigns, measles transmission declined. To determine if there were any remaining immunity gaps to measles or rubella in the population, a nationally representative serosurvey for measles and rubella antibodies was conducted after the outbreak was over. MethodsA nationwide, cross-sectional, stratified, three-stage cluster serosurvey was conducted in November-December 2016. A priori, four regional strata (Ulaanbaatar, Western, Central, and Gobi-Eastern) and five age strata (6 months-23 months, 2–7 years, 8–17 years, 18–30 years, and 31–35 years) were created. Households were visited, members interviewed, and blood specimens were collected from age-appropriate members. Blood specimens were tested for measles immunoglobulin G (IgG) and rubella IgG (Enzygnost® Anti-measles Virus/IgG and Anti-rubella Virus/IgG, Siemens, Healthcare Diagnostics Products, GmbH Marburg, Germany). Factors associated with seropositivity were evaluated. ResultsAmong 4598 persons aged 6 months to 35 years participating in the serosurvey, 94% were measles IgG positive and 95% were rubella IgG positive. Measles IgG seropositivity was associated with increasing age and higher education. Rubella IgG seropositivity was associated with increasing age, higher education, smaller household size, receipt of MMR in routine immunization, residence outside the Western Region, non-Muslim religious affiliation, and non-Kazakh ethnicity. Muslim Kazakhs living in Western Region had the lowest rubella seroprevalence of all survey participants. ConclusionsNationally, high immunity to both measles and rubella has been achieved among persons 1–35 years of age, which should be sufficient to eliminate both measles and rubella if future birth cohorts have ≥ 95% two dose vaccination coverage. Catch-up vaccination is needed to close immunity gaps found among some subpopulations, particularly Muslim Kazakhs living in Western Region.