Childhood Vaccination Programme Research Articles

Childhood vaccination trends during 2019 to 2022 in Tanzania and the impact of the COVID-19 pandemic

ABSTRACT The COVID-19 pandemic has significantly disrupted healthcare systems at all levels globally, notably affecting routine healthcare services, such as childhood vaccination. This study examined the impact of these disruptions on routine childhood vaccination programmes in Tanzania. We conducted a longitudinal study over four years in five Tanzanian regions: Mwanza, Dar es Salaam, Mtwara, Arusha, and Dodoma. This study analyzed the trends in the use of six essential vaccines: Bacille Calmette-Guérin (BCG), bivalent Oral Polio Vaccine (bOPV), Diphtheria Tetanus Pertussis, Hepatitis-B and Hib (DTP-HepB-Hib), measles-rubella (MR), Pneumococcal Conjugate Vaccine (PCV), and Rota vaccines. We evaluated annual and monthly vaccination trends using time-series and regression analyses. Predictive modeling was performed using an autoregressive integrated moving average (ARIMA) model. A total of 32,602,734 vaccination events were recorded across the regions from 2019 to 2022. Despite declining vaccination rates in 2020, there was a notable rebound in 2021, indicating the resilience of Tanzania’s immunization program. The analysis also highlighted regional differences in vaccination rates when standardized per 1000 people. Seasonal fluctuations were observed in monthly vaccination rates, with BCG showing the most stable trend. Predictive modeling of BCG indicated stable and increasing vaccination coverage by 2023. These findings underscore the robustness of Tanzania’s childhood immunization infrastructure in overcoming the challenges posed by the COVID-19 pandemic, as indicated by the strong recovery of vaccination rates post-2020. We provide valuable insights into the dynamics of vaccination during a global health crisis and highlight the importance of sustained immunization efforts to maintain public health.

Comprehensive periodic health evaluations of 454 Norwegian Paralympic and Olympic athletes over 8 years: what did we learn?

ObjectiveA periodic health evaluation (PHE) is a comprehensive and multidisciplinary investigation of athlete health widely used in elite sport, but its contents and benefits can be questioned. This study aimed...

Missed opportunities for human papillomavirus vaccination using Iowa's Immunization Registry Information System.

Adolescent human papillomavirus (HPV) vaccination rates continue to remain lower than other adolescent vaccines, both nationwide and in Iowa. This study examined predictors of missed opportunities for first-dose HPV vaccine administrations in Iowa in order to conduct more targeted outreach and improve adolescent HPV vaccine uptake. A retrospective study was conducted to identify predictors of missed opportunities for first-dose HPV vaccination in Iowa adolescents using Iowa's Immunization Registry Information System. The study population included 154,905 adolescents aged 11-15 years between 2019 and 2022. Missed opportunity for first-dose HPV vaccination was defined as a vaccination encounter where an adolescent received a Tdap and/or MenACWY vaccine but did not receive the first-dose HPV vaccine during the same encounter. Over a third of the study population experienced a missed opportunity for HPV vaccination between 2019 and 2022. Missed opportunity for vaccination was most common among individuals living in a rural county (aOR = 1.36), underinsured adolescents (aOR = 1.74), males (aOR = 1.12), teens 13-15 years of age (aOR = 1.76), and White race and non-Hispanic ethnicity. This study builds on previously reported predictors of missed opportunity for HPV vaccination in adolescents. Increased understanding of provider needs and barriers to administering HPV vaccination and further analysis of how the Vaccines for Children Program can play a role in HPV vaccination uptake is necessary to improve HPV vaccination rates among adolescents in Iowa and more specifically in rural communities.

The impact of quality-adjusted life years on evaluating COVID-19 mitigation strategies: lessons from age-specific vaccination roll-out and variants of concern in Belgium (2020-2022)

BackgroundWhen formulating and evaluating COVID-19 vaccination strategies, an emphasis has been placed on preventing severe disease that overburdens healthcare systems and leads to mortality. However, more conventional outcomes such as quality-adjusted life years (QALYs) and inequality indicators are warranted as additional information for policymakers.MethodsWe adopted a mathematical transmission model to describe the infectious disease dynamics of SARS-COV-2, including disease mortality and morbidity, and to evaluate (non)pharmaceutical interventions. Therefore, we considered temporal immunity levels, together with the distinct transmissibility of variants of concern (VOCs) and their corresponding vaccine effectiveness. We included both general and age-specific characteristics related to SARS-CoV-2 vaccination. Our scenario study is informed by data from Belgium, focusing on the period from August 2021 until February 2022, when vaccination for children aged 5-11 years was initially not yet licensed and first booster doses were administered to adults. More specifically, we investigated the potential impact of an earlier vaccination programme for children and increased or reduced historical adult booster dose uptake.ResultsThrough simulations, we demonstrate that increasing vaccine uptake in children aged 5-11 years in August–September 2021 could have led to reduced disease incidence and ICU occupancy, which was an essential indicator for implementing non-pharmaceutical interventions and maintaining healthcare system functionality. However, an enhanced booster dose regimen for adults from November 2021 onward could have resulted in more substantial cumulative QALY gains, particularly through the prevention of elevated levels of infection and disease incidence associated with the emergence of Omicron VOC. In both scenarios, the need for non-pharmaceutical interventions could have decreased, potentially boosting economic activity and mental well-being.ConclusionsWhen calculating the impact of measures to mitigate disease spread in terms of life years lost due to COVID-19 mortality, we highlight the impact of COVID-19 on the health-related quality of life of survivors. Our study underscores that disease-related morbidity could constitute a significant part of the overall health burden. Our quantitative findings depend on the specific setup of the interventions under review, which is open to debate or should be contextualised within future situations.

Alternative Media to Increase Knowledge About COVID-19 Vaccination in Children

Background: Several vaccination programs for children have not been maximized. The phenomenon of low vaccination coverage in children can be attributed, in part, to the role played by information distribution. Public service advertisements have been widely studied for their effectiveness but are limited to social media. Public service advertisements can be combined with a game. Games are used for health promotion media with various themes and are considered effective. Print media such as posters and combinations with games are media that need to be studied in this digital era. Aims: This study aims to develop public service advertising media to invite COVID-19 vaccinations. Method: This research uses research and development (R&D) with ADDIE stages. The intervention study was conducted in Makassar, South Sulawesi, and involved 40 grade 4 and 6 elementary school students and 65 parents. The intervention was carried out at school by combining posters and pinball games. Measurements are managed with a validated questionnaire to assess knowledge and perceptions. Data were analyzed using the Wilcoxon test. Results: 1) The quality of the media combination of posters and pinball games obtained a score of 3.023 which was included in the qualification of “good” with the recommendation “need some revision” 2) the application of a combination of posters and pinball games affected the knowledge of children; parents’ knowledge is fair and good, and parents’ perceptions are positive. Conclusion: In conclusion, the poster combination game is an alternative media to promote the uptake of COVID-19 vaccination among elementary school students and their parents.

Characteristics associated with non-initiation and non-completion of human papillomavirus vaccination among Danish girls: a nationwide register-based cohort study.

The aim was to identify maternal and paternal socioeconomic and demographic characteristics for non-initiation and non-completion of the human papillomavirus (HPV) vaccination among Danish girls including time-trends. This nationwide register-based cohort study included all girls residing in Denmark who were offered free-of-charge HPV vaccination as a part of the childhood vaccination program between 2009 and 2018 (birth cohorts 1996-2005). The study samples included 296,461 daughter-mother dyads and 291,025 daughter-father dyads. Data from the Danish Vaccination Register were linked with socioeconomic and demographic data from Statistics Denmark. HPV vaccination status was classified as 'non-initiation' for girls who received no HPV vaccine and as 'non-completion' for girls who initiated the HPV vaccination program but did not receive all the scheduled HPV vaccines. Data were analyzed using logistic regression models. Non-initiation of HPV vaccination was 13.7%, and non-completion was 24.2% among girls who initiated the HPV vaccination program. Girls of parents who were descendants of immigrants (adjusted odds ratio: 1.50; 95% confidence interval: 1.35-1.68), were at least 35-years old at time of birth, had basic or no education, had a low income, were not in the labor market, and were unmarried had the highest non-initiation and non-completion odds. The associations between socioeconomic and demographic characteristics and HPV vaccination uptake were similar for mothers and fathers. Despite free-of-charge availability to HPV vaccination in Denmark, we found disparities in non-initiation and non-completion of HPV vaccination among Danish girls by both mothers' and fathers' socioeconomic and demographic characteristics.

Edukasi Pemberian Imunisasi Pada Bayi Dan Balita Di Posyandu Nila B

Vaccination can increase the body's immunity and fight infectious diseases. The level of health of the Indonesian people is decreasing due to the high infant mortality rate, and one effort to overcome this is with a vaccination program for babies and young children. But this program still faces a problem: opposition from parents. Some say that parents' reluctance to vaccinate is caused by people's misunderstanding about vaccines, lack of education, lack of knowledge about vaccines, and the distance between Posyandu Nilla A and Posyandu Nila B, some argue that it is the same whether they want to carry out immunization or not, they will still experience fever, some say the reason is related to religion. This intervention aims to provide education to mothers who do not have access to basic health services. The method used is a lecture method using booklet media which provides direct information to mothers of babies and young children through open interaction. The results of the intervention showed that 81.0% of mothers had good knowledge and 19.0% of mothers had poor knowledge. The conclusion from this intervention is that most mothers know about vaccinations for their children, and it is hoped that good knowledge can help support good vaccinations for their children

Covid-19 Pandemi Sürecinde Sağlıklı Çocuk Takibi ve Kronik Hastalık Kontrollerinin Sürekliliği ve Pandeminin Poliklinik Başvurularına Erken ve Geç Dönemdeki Etkisinin Karşılaştırılması

Aim: Pandemic disrupted health care access in many centers all around the world. CDC recommended that seperating pandemic and non-pandemic hospitals, prioritizing emergency visits, postponing elective operations and, where possible, converting outpatient visits to telehealth calls. In this period, well-child checkups were cancelled and routine childhood vaccination was interrupted. We aimed to evaluate the impact of pandemic on the routine immunization schedule, neonatal screening program, chronic disease follow ups and outpatient clinic visits. 
 Material and Method: In total, 401 children and their parents were included in this study and patient population of interest was children of routine immunization age. Outpatient visit features and compliance with the childhood vaccination and neonatal screening program before and during the pandemic were asked. 
 Results: Compared to 2021, there was a significant increase in both the number of patients with upper respiratory tract infection symptoms and their hospital admissions. While the rates of hospital admissions increased in 2022 in those with diarrhea, almost all of the patients with lower respiratory tract infection symptoms stated that they applied to the hospital in both periods. It was observed that routine vaccination and newborn screening programs were carried out successfully during the pandemic process in Turkey. It was found that chronic disease follow-ups of children were interrupted in 2021. 
 Conclusion: This study has shown how the 3 major components of health system (outpatient clinic visits, well child check-ups and chronic disease follow-ups) were affected at different times of the pandemic in Turkey. Successful management in childhood vaccinations and neonatal screening program should also be ensured in chronic disease follow-up bythe separation of pandemic and non-pandemic hospitals. Showing the strengths and weaknesses of strategies implemented in health system during the pandemic guides the measures to be taken for similar situations that may occur in the future.

The 2020 immunization programme landscape: Piloting an assessment metric to evaluate the maturity of national immunization programmes across the life course

BackgroundThe World Health Organization (WHO) encourages countries to provide appropriate vaccinations for children, adolescents, and relevant adult populations. Childhood programme have been the focus of global investments, but recent pandemics have increasingly demonstrated the value of life course vaccination. Our objective is to compare national life course immunization programmatic maturity prior to mass COVID-19 vaccine introduction, the largest adult vaccination programme, globally. As coverage estimates (typically used to assess childhood programmes) are not available for adult vaccinations, this analysis pilots a standardized quantitative metric of programmatic maturity. MethodsThrough consultation with vaccination experts, we developed a standardized approach to assess national immunization programme maturity across the life course. In accordance with expert input, five vaccines were selected to represent delivery across the life course: diphtheria tetanus toxoid and pertussis (DTP); measles (MCV) second dose; human papillomavirus (HPV) final dose; pneumococcal conjugate (PCV) final dose; and seasonal influenza annual dose. Experts recommended inclusion of the following indicators for each vaccine: a legal mandate (national policy), experience delivering the vaccine (programme duration), and vaccine use (uptake for relevant populations). We developed a metric accordingly that provides up to 5 points per vaccine (“vaccine specific maturity score”) which when summed forms the “life course maturity score”, with a maximum score of 25. We analysed the prevalence of national policies, experience, and use by region and World Bank income group. ResultsMore than 55% of the 194 WHO Member States had childhood vaccine policies for all three of the vaccines considered (DTP, MCV, and PCV) compared to 60% for HPV (proxy for adolescent vaccination programme) and 52% for seasonal influenza (proxy for adult vaccination programme). Childhood vaccination programmes (e.g., MCV and DTP) had the highest vaccine specific maturity scores, while seasonal influenza and HPV vaccination programmes had much lower scores. The national life course maturity scores ranged from 1 to 23, with a global median of 12 (IQR: 8; 16). DiscussionThe piloted metric provides an overview of the maturity of life course immunization programmes. The metric is structured to be a flexible, rapid resource that can be used to assess other combinations of vaccines across the life course. The findings from this paper provide a baseline of immunization programme maturity for childhood, adolescent, and adult vaccination programmes immediately prior to the COVID-19 vaccine introduction. This maturity score, or adaptations of this approach, could be used to monitor the trajectory of national immunization programme maturity across the life course in the years ahead.

A narrative review of strategies to improve childhood vaccination coverage in Low- and Middle-Income Countries

Background: Childhood vaccination is a fundamental human right and a core component of successful primary care. It has positive benefits on population health as it reduces the burden and costs associated with infectious diseases. Main Body: Despite the immense benefits of childhood vaccination, vaccine coverage remains poor in many Low- and Middle-Income Countries (LMICs) due to several barriers. Examples of these barriers include parental misperceptions about vaccine safety, poor vaccine distribution networks and insufficient funding for childhood vaccination programs. It is therefore necessary to design suitable and effective strategies to overcome these barriers. Conclusion: This narrative review article discusses effective strategies to improve vaccine coverage in Low- and Middle-Income Countries (LMICs).

The assessment of the social and economic impacts of public health interventions based on the statistical learning

This study explores the social and economic impacts of public health interventions against the backdrop of the COVID-19 pandemic. The emergence of the pandemic has highlighted the critical importance of effective public health measures in safeguarding societys well-being. With a focus on statistical learning techniques, this research examines the effects of interventions such as vaccination programs, tobacco regulations, and obesity reduction initiatives. Through a comprehensive literature review and data analysis of childhood vaccination programs in the United States, the study reveals significant benefits in terms of disease prevention, improved health outcomes, and reduced healthcare costs. The case study of San Francisco further demonstrates the success of vaccination campaigns in controlling preventable diseases. Based on these findings, policy recommendations are provided, emphasizing the integration of multiple intervention approaches, the prioritization of vulnerable populations, and the implementation of awareness campaigns and educational programs.

Evaluation of alignment of the reimbursement medicines list for children in Albania with the WHO essential medicines list for children.

The WHO Essential Medicine List for Children was released on the 30th anniversary of the general Essential Medicine List in 2007, to recognise special needs for medicines in children, and to promote the inclusion of paediatric medicines in national procurement programmes. This study aimed to investigate the alignment of the medicines included in the Albanian reimbursement medicines list of the Mandatory Healthcare Insurance Fund (AMHIF) and the Essential Medicine List for Children. A quantitative evaluation was performed to compare the paediatric medicines included in the 2022 list of the AMHIF and the 2021 WHO Essential Medicine List for Children. In addition, vaccines in the Albanian vaccination programmes for children were compared to the ones listed on the WHO Essential Medicine List for Children. Both lists had a total of 284 active ingredients in common, whereas 14 of 24 vaccines were found to be in common in the Essential Medicine List for Children list and the Albanian vaccination programmes. This is the first study in Albania to investigate the alignment of the WHO EMLc and AMHIF list. In case of the same active ingredient there were many deviations in terms of dosage form, strength and indication.

Abstract C067: Evaluation of data from a new mobile HPV vaccination program in South Carolina, U.S.

Abstract Purpose: Human papillomavirus (HPV) infections are linked to at least six different types of cancer. The Medical University of South Carolina (MUSC) Hollings Cancer Center (HCC) and Department of Pediatrics leaders identified less-than-optimal HPV vaccination rates in rural and medically underserved communities in South Carolina (SC) (80% in urban cities vs. 62% in rural areas). Forty-three percent of SC’s 46 counties include areas classified as rural by the U.S. Census, and 14% of the state’s population lives in rural areas. SC’s population demographics are typical of the Deep South region of the U.S. and primarily comprise non-Hispanic White (69%) and non-Hispanic Black (27%) residents, with a small but growing Hispanic/Latinx population (6.0%). SC compares unfavorably with the U.S. averages in educational levels and per capita and median household incomes. These social determinants of health-related factors contribute to lower levels of knowledge about, and access to, the HPV vaccine. Methods: To address the major public health issue of low HPV vaccination rates in rural SC, the MUSC HCC and Department of Pediatrics created a statewide community engagement-focused HPV Vaccination Van Program with funding from the HealthyMe/HealthySC (HMHSC) program and MUSC HCC. The Program launched in October of 2021. It provides HPV and other childhood vaccinations in school districts, HMHSC health clinics, and other community settings throughout SC, focusing on children aged 9–18 years who are eligible for the U.S. Centers for Disease Control and Prevention’s Vaccines for Children Program. The prioritization of the selection of counties for inclusion in the Program is based on geospatial analyses highlighting the current HPV vaccination rates in each county. Results: As of 5 June 2023, the Program has administered childhood vaccinations to 734 participants in 28/46 counties (60%) of SC. Three-hundred and forty-six of the participants received HPV vaccinations. They were predominantly female (56.4%), aged 4–18 years (97.1%), and self-identified as non-Hispanic White (46.0%), non-Hispanic Black (31.9%), Hispanic/Latino (14.9%), Asian American (1.2%), Multiracial (3.3%), or Other (2.4%), with 0.3% of the participants not reporting their racial/ethnic identification. Slightly more than half of the participants (52.9%) had Medicaid insurance and 25.1% reported having no insurance coverage. Conclusions: The number of children receiving the HPV vaccine through the Program, and the number of counties served, is expected to expand as the Program’s relationship with SC’s school districts and other community-based organizations grows. The Program provides a model for delivering mobile HPV vaccinations to rural children, thus reducing their cancer risk. Citation Format: Marvella E. Ford, Kathleen B. Cartmell, Angela M. Malek, Nhi Phuong Le, Chloe Keeve, I'Ayana Sanders, Jerlinda Ross, Melanie Slan, Joan McLauren, Mina Platt, Ellen Gomez, Jessica Zserai, Beth Poore, Christina Cody, Victoria Ladd, Mary S. Beattie, J. David Suddoth, Kapri Kreps, James R. Roberts. Evaluation of data from a new mobile HPV vaccination program in South Carolina, U.S. [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C067.

Determinants of parental vaccine hesitancy in Canada: results from the 2017 Childhood National Immunization Coverage Survey

BackgroundIn 2019, the World Health Organization (WHO) designated vaccine hesitancy as one of the ten leading threats to global health. Vaccine hesitancy exists when vaccination services are available and accessible, but vaccine uptake is lower than anticipated. It is often attributed to lack of trust in vaccine safety and effectiveness, or low level of concern about the risk of many vaccine-preventable diseases. This study aimed to examine the sociodemographic factors associated with parental vaccine hesitancy and vaccine refusal in Canada using data from the 2017 Childhood National Immunization Coverage Survey (CNICS).MethodThe 2017 CNICS was a cross-sectional and nationally representative survey to estimate national vaccine uptake and to collect information about parents’ Knowledge, Attitudes and Beliefs (KAB) regarding vaccination. Using the KAB questions, parental vaccine hesitancy (i.e., parental hesitation, delay or refusal of at least one recommended vaccination) and refusal (i.e., unvaccinated children) by sociodemographic factors was estimated using weighted prevalence proportions. A multinomial logistic regression model was fitted to examine associations between parental vaccine hesitancy or refusal and sociodemographic factors among parents of two-year-old children in Canada. Adjusted odds ratios (aOR) of being vaccine-hesitant or vaccine-refusing versus being non-vaccine-hesitant were generated.ResultsBoth unadjusted and adjusted logistic regressions models showed that parents with lower household income (aOR 1.7, 95% CI 1.2–2.5), and those with a higher number of children in the household (aOR 2.2, 95% CI 1.4–3.5) had higher vaccine hesitancy. Conversely, lower vaccine hesitancy was observed among non-immigrant parents (aOR 0.4, 95% CI 0.3–0.6). In addition, lower household income (aOR 4.0, 95% CI 1.3–12.9), and higher number of children in the household (aOR 6.9, 95% CI 2.1–22.9) were significantly associated with parental vaccine refusal. Regional variations were also observed.ConclusionSeveral sociodemographic determinants are associated with parental vaccine hesitancy and refusal. The findings of the study could help public health officials and policymakers to develop and implement targeted interventions to improve childhood vaccination programs.

Indirect impact of PCV10 children vaccination on the serotype distribution and antimicrobial resistance of Streptococcus pneumoniae causing invasive disease in adults over 50 in Colombia, 2005–2019: Observational analysis

IntroductionThe introduction of pneumococcal conjugate vaccine (PCV) into childhood vaccination programmes has reduced the prevalence of vaccine serotypes (VTs) that cause invasive pneumococcal disease (IPD) in children. In the elderly population, an impact has also been seen through indirect protection (herd effect). The aim of this study was to estimate the changes in serotype distribution and antimicrobial susceptibility of Streptococcus pneumoniae isolates recovered from adult IPD and to evaluate the indirect effect of immunization with PCV10 based on laboratory records by analyzing the period from 2005 to 2019 for six years before and eight years after the universal PCV10 administration to Colombian children. MethodsA total of 2204 S. pneumoniae isolates from adults (≥50 years) with IPD were analyzed. The analysis examined the percentage changes in proportions (prevalence) and percentage variations in population rates (annual reported rates – ARR) of VTs between the pre-PCV10 (2005–2009) and post-PCV10 (2015–2019) periods. ResultsThe findings were (1) evidence of a significant percentage decrease of pneumococcal VT10 causing IPD in adults (50% pre-PCV10 and 16% post-PCV10); (2) significant increase of serotype 19A (from 1.6% to 14.8%) and less important increase of serotype 3 (from 10.5% to 14.5%) and non-vaccine serotypes (NVT) (from 21.4% to 38.4%) non-significant; and (3) meningitis and non-meningitis multidrug resistant isolates associated with serotype 19A. An improvement in the surveillance system is associated with the immunization of children, as noted by the increased ARRs across the analysis period. ConclusionsOur results show the indirect impact of PCV10 vaccination in children on the VT10 distribution and antimicrobial resistance of S. pneumoniae causing IPD in Colombian adults over 50 when comparing the pre-PCV10 (2005–2009) and post-PCV10 (2015–2019) periods.

Ethnic inequities in routine childhood vaccinations in England 2006–2021: an observational cohort study using electronic health records

Population groups that are underserved by England's childhood vaccination programme must be identified to address the country's declining vaccination coverage. We examined routine childhood vaccination coverage in England by maternal ethnicity between 2006 and2021. We created first, second and fifth birthday cohorts using mother-child linked electronic health records from the Clinical Practice Research Datalink (CPRD) Aurum. After validation against the UK Health Security Agency (UKHSA) and National Health Service England (NHSE) annual statistical reports, we described vaccination coverage for each vaccine by ethnicity and year. We used modified Poisson regression to analyse the effect of ethnicity on receiving the primary and full course of each vaccine. Up to 1,170,804 children born after 1 April 2006 were included in the first birthday cohort, reducing to 645,492 by the fifth birthday. Children were followed up until 31 March 2021at the latest. Children born to mothers in 9 minority ethnic groups and those of unknown ethnicity had lower vaccination coverage (61.3-97.5%) than the White British group (79.9-97.8%) for all vaccines. Indian, Pakistani, Bangladeshi, Chinese, Any other Asian background, and White and Asian ethnic groups had similar vaccination coverage to the White British group (above 90% for most vaccines in most years). Inequities particularly affected the Caribbean group (e.g. 61% coverage for the 6/5/4-in-1 full course in 2020-21 by children's fifth birthday; RR 0.66, 95% CI 0.6-0.74 compared with the White British group) and Any other Black, African and Caribbean background (e.g. coverage 68% for the MMR primary course in 2020-21; RR 0.71, 95% CI 0.64-0.78). These inequities widened over the study period. For example, the absolute difference in coverage between the Caribbean and White British groups for the full course of MMR increased from 12% in 2011-12 to 22% in 2019-20. These inequities remained even after accounting for sociodemographic, maternal and birth related factors, and also widened from primary course to full course. Our findings suggest that urgent policy action is needed to address the ethnic inequities throughout England's routine childhood vaccination programme, which have been worsening over time. University of Oxford Clarendon Fund, St Cross College and Nuffield Department of Population Health.

Estimated number of reported vaccine-preventable disease cases averted following the introduction of routine vaccination programs in Sweden, 1910-2019.

Routine childhood vaccination programs have had enormous positive public health impacts worldwide. However, in some areas, these benefits may be impeded by vaccine hesitancy and undervaccination. We estimated the number of reported cases of measles, pertussis, mumps and poliomyelitis averted in Sweden after the introduction of routine childhood vaccination programs. We used annual national data on population size and the number of reported cases of measles (1911-2019), pertussis (1911-2019), mumps (1914-2019) and poliomyelitis (1910-2019) for Sweden. For each disease, we calculated the median and 95% confidence interval of the annual pre-vaccination incidence to estimate the number of counterfactual cases; that is, the estimated number of cases that would have been observed in the post-vaccination period had no vaccine been introduced (median incidence × average annual population). For the post-vaccination periods, we calculated reported cases averted and assumed all decreases were due to vaccines. In total, for all four diseases combined, over 2.1 million cases were reported over the respective surveillance periods. Since the introduction of vaccinations, we estimate that over 1.5 million reported cases of these four diseases combined have been averted: measles (633 091), pertussis (608 670), mumps (262 951) and poliomyelitis (58 240). However, due to underreporting, especially during pre-vaccination years, these are likely underestimates. Since the introduction of these routine childhood vaccination programs in Sweden, a substantial number of reported cases of vaccine-preventable diseases have been averted. Vigilance against both failure to vaccinate and undervaccination is necessary to prevent future increases of these vaccine-preventable diseases.

What factors contribute to parental vaccine hesitancy for children aged 0–5 years?

A growing proportion of children in England aged 0–5 years are not being vaccinated in line with the national immunisation schedule. Evidence suggests that this is, in part, due to parents declining all or some vaccinations. A deeper understanding of the reasons behind parental ‘vaccine hesitancy’ would enable effective health promotion approaches to ensure the success of childhood vaccination programmes. With this in mind, a literature review was conducted. Analysis of the selected papers identified emerging themes that contributed to parental vaccine hesitancy for children aged 0–5 years. These included a lack of parental perception that routine vaccines are needed; safety concerns for vaccines being offered; and a belief that a child’s immune system would be ‘overloaded’ if several vaccines were given at one time. The findings suggest a collaborative approach between parents, health professionals and stakeholders is needed to tackle the problem of parental vaccine hesitancy.

Effect of the COVID-19 pandemic on the pediatric infectious disease landscape.

This narrative review aims to present an overview of the COVID-19 pandemic's effects on the landscape of pediatric infectious diseases. While COVID-19 generally results in mild symptoms and a favorable prognosis in children, the pandemic brought forth significant consequences. These included persistent symptoms among infected children ("long COVID"), a profound transformation in healthcare utilization (notably through the widespread adoption of telemedicine), and the implementation of optimization strategies within healthcare settings. Furthermore, the pandemic resulted in alterations in the circulation patterns of respiratory pathogens, including influenza, RSV, and Streptococcus pneumoniae. The possible reasons for those changes are discussed in this review. COVID-19 effect was not limited to respiratory infectious diseases, as other diseases, including urinary tract and gastrointestinal infections, have displayed decreased transmission rates, likely attributable to heightened hygiene measures and shifts in care-seeking behaviors. Finally, the disruption of routine childhood vaccination programs has resulted in reduced immunization coverage and an upsurge in vaccine hesitancy. In addition, the pandemic was associated with issues of antibiotic misuse and over-prescription. Conclusion: In conclusion, the COVID-19 pandemic has left a profound and multifaceted impact on the landscape of pediatric infectious diseases, ranging from the emergence of "long COVID" in children to significant changes in healthcare delivery, altered circulation patterns of various pathogens, and concerning disruptions in vaccination programs and antibiotic usage. What is Known: •COVID-19 usually presents with mild symptoms in children, although severe and late manifestations are possible. •The pandemic resulted in a dramatically increased use of health care services, as well as alterations in the circulation patterns of respiratory pathogens, decreased rates of other, non-respiratory, infections, disruption of routine childhood vaccination programs, and antibiotic misuse. What is New: •Possible strategies to tackle future outbreaks are presented, including changes in health care services utilization, implementation of updated vaccine programs and antibiotic stewardship protocols. •The decline in RSV and influenza circulation during COVID-19 was probably not primarily related to NPI measures, and rather related to other, non-NPI measures implementation, including specific pathogen-host interactions on the level of the biological niche (the nasopharynx).

A COVID-19 vaccination program for high-risk children aged 12-17 years in Curacao.

This study aimed to describe and critically evaluate the COVID-19 vaccination program for high-risk children in Curacao and provide information about important factors such as parents' vaccination hesitancy and effective strategies for communicating and delivering information about vaccination. This was a cross-sectional study. It was important to identify children aged 12-17 years who were at high risk of severe COVID-19 infection because of the limited medical facilities on the island; children considered to be at high risk were those with diseases such as obesity, hypertension or diabetes mellitus type 2. These children or their caregivers were invited by their pediatricians to be vaccinated as part of a program run by the Public Health Department of Curacao. These high-risk patients were vaccinated between 30 May 2021 and 25 February 2022 in designated child-friendly spaces, with a pediatrician present for guidance and reassurance. Children received the Pfizer-BioNTech COVID-19 vaccine at the recommended dose for their age. The primary outcome was a description and evaluation of the attendance for vaccination. The secondary outcomes were side effects after vaccination for the age groups 12-15 years and 16-17 years. Reasons for refusal or nonadherence were also registered. Altogether 51% (24/47) of those aged 16-17 years who were invited were vaccinated compared with 42% (26/69) of those aged 12-15 years who were invited. Altogether, 46% of these high-risk children were vaccinated compared with 48% of children aged 12-17 years without risk factors. In our population, most patients did not experience any side effects and if they did, the side effects were mild. No cases of myocarditis or pericarditis were observed. A lack of trust in the vaccine and a lack of prioritization of vaccination when scheduling daily activities were important factors in refusal and nonadherence. To organize a successful vaccination program in a small community with limited resources for treating high-risk children it is crucial for medical professionals to provide reliable information. Public health initiatives should focus on assuaging parents' fears about vaccines. In addition, ensuring there is good cooperation between doctors and the Public Health Department can help to make implementation successful. Finally, involving pediatricians and using dedicated areas for vaccinating children can help build trust with parents and caregivers.