Cost-effective Public Health Measure Research Articles

Accelerating Global Measles and Rubella Eradication-Saving Millions of Lives, Preventing Disability, and Averting the Next Pandemic.

No vaccine has been more effective in reducing disease burden, especially in preventing child deaths, than measles-containing vaccine. The return on investment makes measles-containing vaccine one of the most cost-effective public health measures available. Exhaustive reviews of biological, technical, economic and programmatic evidence have concluded that measles can and should be eradicated, and by including rubella antigen in measles-containing vaccine, congenital rubella syndrome will also be eradicated. All World Health Organisation Regions have pledged to achieve measles elimination. Unfortunately, not all countries and global partners have demonstrated an appropriate commitment to these laudable public health goals, and the negative impact of the COVID-19 pandemic on coverage rates has been profound. Unsurprisingly, large disruptive outbreaks are already occurring in many countries with a global epidemic curve ominously similar to that of 2018/2019 emerging. The Immunization Agenda 2030 will fail dismally unless measles and rubella eradication efforts are accelerated. Over half of all member states have been verified to have eliminated rubella and endemic rubella transmission has not been re-established in any country to date. In 2023, 84 countries and areas were verified to have sustained elimination of measles. However, without a global target, this success will be difficult to sustain. Now is the time for a global eradication goal and commitment by the World Health Assembly. Having a galvanising goal, with a shared call for action, will demand adequate resourcing from every country government and global partners. Greater coordination across countries and regions will be necessary. Measles, rubella and congenital rubella syndrome eradication should not remain just a technically feasible possibility but rather be completed to ensure that future generations of children do not live under the shadow of preventable childhood death and lifelong disability.

Cost-efficient child vaccination project results from hard-to-reach rural communities in Kenya

Abstract Child immunization is a cost-effective public health measure for reducing child morbidity and mortality. Child immunization coverage in Kenya has improved in recent years, with coverage rates for most vaccines exceeding 80%. However, there are still pockets of low coverage, particularly in remote or hard-to-reach areas. We implemented a community-based project to improve access and equity in child immunization services in three Kenyan counties (Nairobi, Wajir and Mandera). We trained health workers, promoted community acceptance, and provided logistical support to Ministry of Health (MoH) for child immunization services through community outreach centers. During the project period (January 2020 to February 2023), our project facilitated full immunization coverage for 93,879 children and we reached 200,554 community members whom we communicated relevant messages for recommended practice about health, nutrition and child vaccination. Our project achieved a 26 percentage-point increase (increased from 62% at baseline in 2020 to 88% at endline in 2022) in age-appropriate child vaccinations by end of the project. We also conducted a cost-efficiency analysis by taking the actual costs incurred and project achievements into account. The key results from the cost-efficiency analysis revealed approximate cost for a fully immunized child as 21 US dollar, while per capita cost for communicating health messages to community members and health care worker training was 10 US dollar. UNICEF estimated approximately 32 US$ as vaccine delivery cost (=total cost - cost of vaccine and supply) per fully vaccinated child with standard schedule for children < 24 months which is higher than the cost for ensuring a fully immunized child in our project. These data clearly indicate the efficiency and success of community-based approach for strengthening MoH child immunization services in Kenyan rural and hard-to-reach communities. Key messages • Strong collaboration with Ministry of Health and community participation are critical key aspects for implementing child vaccination program successfully and cost-efficiently in rural communities. • Facilitating Ministry of Health for health system strengthening focus yields sustainable impact as footprint after end of a short-term of a community based project in developing country settings.

Influencing the global governance of alcohol: Alcohol industry views in submissions to the WHO consultation for the Alcohol Action Plan 2022-2030.

In 2020, the Secretariat of the World Health Organization (WHO) conducted an open consultation, with public submissions, for the purpose of developing an Alcohol Action Plan to "strengthen implementation" of the WHO's 2010 Global Strategy to Reduce the Harmful Use of Alcohol. The consultation process and public submissions provided an opportunity to critically examine alcohol industry perspectives and arguments in relation to the global governance of alcohol. 48 alcohol industry submissions to the WHO's 2020 consultation were included for analysis. Directed content analysis was used to examine the policy positions and arguments made by industry actors. Thematic analysis was employed to further explore the framing of industry arguments. In framing their arguments, alcohol industry actors positioned themselves as important stakeholders in policy debates; differentiated "normal" drinking from consumption that merits intervention; argued that alcohol policy should be made at the national, rather than global, level; and supported industry self-regulation or co-regulation rather than cost-effective public health measures to prevent harms from alcohol. The alcohol industry's submissions to the WHO's 2020 consultation could be seen as efforts to stymie improvements in the global governance of alcohol, and repeats several framing strategies that the industry has used in other forums, both national and global. However, their arguments appear to have had little traction in the creation of the Alcohol Action Plan. Changes from the Working Document to the adopted Action Plan show little acceptance by WHO of industry arguments.

Multivalent vaccines demonstrate immunogenicity and protect against Coxiella burnetii aerosol challenge.

Vaccines are among the most cost-effective public health measures for controlling infectious diseases. Coxiella burnetii is the etiological agent of Q fever, a disease with a wide clinical spectrum that ranges from mild symptoms, such as fever and fatigue, to more severe disease, such as pneumonia and endocarditis. The formalin-inactivated whole-cell vaccine Q-VAX® contains hundreds of antigens and confers lifelong protection in humans, but prior sensitization from infection or vaccination can result in deleterious reactogenic responses to vaccination. Consequently, there is great interest in developing non-reactogenic alternatives based on adjuvanted recombinant proteins. In this study, we aimed to develop a multivalent vaccine that conferred protection with reduced reactogenicity. We hypothesized that a multivalent vaccine consisting of multiple antigens would be more immunogenic and protective than a monovalent vaccine owing to the large number of potential protective antigens in the C. burnetii proteome. To address this, we identified immunogenic T and B cell antigens, and selected proteins were purified to evaluate with a combination adjuvant (IVAX-1), with or without C. burnetii lipopolysaccharide (LPS) in immunogenicity studies in vivo in mice and in a Hartley guinea pig intratracheal aerosol challenge model using C. burnetii strain NMI RSA 493. The data showed that multivalent vaccines are more immunogenic than monovalent vaccines and more closely emulate the protection achieved by Q-VAX. Although six antigens were the most immunogenic, we also discovered that multiplexing beyond four antigens introduces detectable reactogenicity, indicating that there is an upper limit to the number of antigens that can be safely included in a multivalent Q-fever vaccine. C. burnetii LPS also demonstrates efficacy as a vaccine antigen in conferring protection in an otherwise monovalent vaccine formulation, suggesting that its addition in multivalent vaccines, as demonstrated by a quadrivalent formulation, would improve protective responses.

Challenges and obstacles implementing evidence-based food fortification policy in a high-income country.

The World Health Organization (WHO) recognizes food fortification as one of the most cost-effective and beneficial public health measures available. Mass fortification policies and regulations can reduce health disparities, including in high-income countries, by improving micronutrient intake among food-insecure or high-risk populations without changing their diet or behavior. While international health organizations have traditionally prioritized technical assistance and grants to medium and low-income countries, it is important to recognize that micronutrient deficiencies may also pose an important yet underappreciated public health problem in many high-income countries. Nevertheless, some high-income countries, including Israel, have been slow to adopt fortification, due to a variety of scientific, technological, regulatory, and political barriers. Overcoming these barriers requires an exchange of knowledge and expertise among the all stakeholders to achieve cooperation and broad public acceptance within countries. Similarly, sharing the experience of countries where the matter is in play may help inform efforts to advance fortification globally. Here we share a perspective on progress and barriers to achieve this goal in Israel, to inform efforts made to avoid the regrettable waste of unrealized human potential from prevalent yet preventable nutrient deficiency conditions, in Israel and beyond.

Knowledge and Practice Regarding The Administration Of the Pentavalent Vaccine Among Health Care Workers In Vientiane Capital, Lao PDR: A Mixed Method Approach

Knowledge and practice regarding the administration of the pentavalent vaccine among health care workers in Vientiane Capital, Lao PDR: A mixed method approach Abstract Background: The pentavalent vaccine is an essential, cost-effective public health measure to reduce preventable premature child mortality and childhood mobility and contributes to lowering the spread of vaccine-preventable diseases. The aim of this study is to assess the knowledge and practice of providing pentavalent vaccines and its related factors among health care workers (HCWs). Method: This was a cross-sectional analytical study, using the qualitative and quantitative methods. The study was conducted in nine district hospitals and 33 health centers in Vientiane Capital. In total, 184 health care workers were involved in the study and in-depth interviews were conducted with 12 HCWs. Descriptive and inferential statistics were applied to determine the factors associated with the knowledge and the practice of pentavalent vaccines. A thematic analysis was applied to the qualitative data. Results: The results showed that more than half (63.3%) had poor knowledge of the pentavalent vaccine, while about two thirds (65.7%) reported good practices for delivering the pentavalent vaccine. In the multiple logistic regression, significant factors associated with the knowledge of the pentavalent vaccine were the qualification of HCWs (AOR=2.6, 95% CI=1.1 – 6.3, p=0.030), receiving training on vaccines (AOR=3.4, 95% CI=1.7 – 6.8, p<0.001), and incentives of working for vaccination programmes (AOR=2.7, 95% CI=1.2 – 6.1, p=0.020). The qualitative study revealed the need to improve supply-side determinants including increased training to improve the health staff’s competency, knowledge and practice of immunization. Conclusion: The data from this research indicated that more than half of the HCWs had poor knowledge about the pentavalent vaccine, despite vaccination practice being relatively good. There was a correlation between improved knowledge, with those HCWs who had higher education, and received training and incentives. These findings demonstrate there is a need for more efficient training and the continuous education of HCWs in the field of immunization. Keywords: Pentavalent vaccine, health care workers, knowledge and practice, Lao PDR.

COVID-19 Vaccination Distribution and Uptake: Addressing Vaccine Hesitancy in Canada

The COVID-19 pandemic has prompted the urgent development and distribution of novel vaccinations to reduce the global disease burden and establish herd immunity. Vaccination is a cost-effective public health measure that is critical for disease prevention; as of March 2022, Health Canada has authorized the distribution of the Pfizer-BioNTech and Moderna mRNA COVID-19 vaccines in pediatric populations. However, vaccine hesitancy among caregivers remains a significant barrier to vaccine uptake in the pediatric population. Increased research on the intentions, motivations, and perceptions of pediatric COVID-19 vaccine efficacy and safety may facilitate the development of public health strategies to address pediatric vaccine knowledge translation, accessibility, and administration barriers. This perspective paper aims to explore the major barrier of vaccine hesitancy and potential solutions to achieve effective vaccine uptake in the Canadian pediatric population.

Triple fortification of salt with iron, iodine and zinc oxide using extrusion

Diets poor in essential vitamins and minerals, also known as micronutrients, are widespread worldwide. Food fortification is considered to be the most cost-effective approach to addressing micronutrient deficiencies in regions consuming poor diets. We have developed a cost‐effective technology to simultaneously deliver zinc, iron, and iodine through salt as a strategy to combat iron and zinc deficiencies. Two different approaches for adding zinc to the double fortified salt were investigated: spraying in solution, or incorporation into a solid premix. Zinc sulfate or zinc chloride was added to the iodate spray solution or zinc oxide was added into the iron premix used for making Double Fortified Salt. Of these two approaches, incorporating zinc into iron premix was superior, based on the stability of fortificants. For incorporating zinc into the iron premix, zinc oxide was either included in the extruded premix core or used as part of the color masking system with titanium dioxide (TiO2). The latter approach proved to be preferable as it resulted in higher iodine retention after one year of storage. This technology is a cost-effective public health measure for improving the health of populations with diets deficient in these critical micronutrients.

Health Literacy on Human Papillomavirus, its Vaccination and Risk Factor of Cervical Cancer among Adolescent Girls

Human Papilloma Virus is a group of >150 related viruses and precursor to nearly all cervical cancers and genital warts. Cervical cancer ranks 1st most frequent cancer in Nepal among 15-44 years of age women. World Health organization recommends vaccination for 9–13-year-old girls as most cost-effective public health measure to diminish the risk of HPV transmission against cervical cancer. The study aimed to assess the level of knowledge and attitude on HPV, its vaccination and risk factor of cervical cancer among adolescent girls. A descriptive cross-sectional research was conducted among 400 adolescent girls at selected schools of Dharan through Systematic Random Sampling. Data were collected using Self-administered questionnaire and analyzed using descriptive and inferential statistics at the level of significance 0.05 in SPSS version16. Majority (83.0%) of the respondents were of Middle Adolescence (14-16yrs) with mean age 15.48 years and standard deviation of ±1.031. More than half (52.8%) of respondents had adequate knowledge whereas more than half (55.5%) of respondents had negative attitude. There was no association between knowledge and attitude with socio-demographic variables. The correlation between levels of knowledge and attitude was positively significant with P value 0.01(r=0.243).The study revealed that more than half of adolescent girls had adequate knowledge where as less than half of respondents had positive attitude and there was no association between knowledge, attitude and socio-demographic variables but correlation between knowledge and attitude was found to be positive.

THE EFFECT OF BREASTFEEDING ON THE HEALTH INDICATORS OF YOUNG CHILDREN

Promotion and coverage of breastfeeding are considered to be the cost-effective public health measures in terms of Healthcare System. The aim of the research is to assess an influence of breastfeeding on infants’ health and quality of life (QL) parameters. This observational prospective study included 1790 newborns selected from Yerevan State Medical University’s Polyclinics (“Mouratsan”, sample=746, and “Heratsi”, sample=1044). Data collection took a period between January 2016 and December 2017. Evaluation of children’s quality of life was performed with the help of the validated and adapted QUALIN questionnaire. The data related to child’s health condition were collected from the “Child Development History” cards available at the polyclinics of the investigated area. Among 1770 one year old children 1681 were ever breastfed, 1224 (69.1%) were exclusively breastfed up to 3 months, the median duration of breastfeeding was 6–7 months, 45% were breastfed for more than 6 months, and 15% were breastfed for more than 1 year. There is a significant difference between the QL scores of the ever breastfed and the never breastfed subgroups. Duration of the breastfeeding also have an influence on QL scores. The given study’s results confirm that breastfeeding among the early aged Armenian children is of great importance in their health, influencing on quality of life and morbidity rates.

KNOWLEDGE AND PRACTICES OF HAND WASHING AMONG HEALTH WORKERS IN EMERGENCY DEPARTMENT OF A TERTIARY CARE HOSPITAL IN KOLKATA

Introduction: Nosocomial infections due to poor hand hygiene are a major cause of increasing morbidity, mortality and health care costs among hospitalized patients worldwide. The high prevalence of these infections, as high as 19%, in developing countries poses a challenge to health care providers. Hand hygiene is considered the single most cost-effective public health measure for preventing health care associated infection (HCAI). Aims: To assess the compliance, identify factors inuencing compliance and to study the knowledge, attitude and perceptions associated with HH among health care workers (HCW). Materials and method: This was a single centre cross sectional study from tertiary care hospital in kolkata, India from February 2021 – February – 2022 were included all healthcare workers who are directly involved in management of the patient (Doctors, Nursing stuff, paramedic stuff and group D stuff) in this study. Result: Knowledge about proper and consistent hand washing prevents infections in health facilities was signicantly high in doctor group [49(98.0%)], in nurse group [47(94.05%)] and in others group [43(86.0%)]. (P=0.0488). Knowledge about no need for hand washing for those who perform their activity with caution was signicantly more in others group [13(26.0%)] and in nurse group [3(6.0%)]. (P<0.0001). Doctor had [48(96.0%)] always and [2(4.0%)] usually practice of hand washing about after contact with patients, most of the nursess had always [38(76.0%)], Usually [7(14.0%)], often [3(6.0%)] and somestimes 2(4.0%) practice of hand washing about after contact with patients and lower number of others had [5(10.0%)] often ,[6(12.0%)] somestimes, [18(36.0%)] always and [18(36.0%)] Usually practice of hand washing about after contact with patients but this was statistically signicant (P<0.0001). Conclusion: Majority of the study participants were knowledgeable. However, they had poor practice of hand washing

Knowledge and Awareness of Parents Towards Human Papillomavirus (HPV) and HPV Vaccines, and Vaccine Acceptability in Northern Cyprus.

The human papillomavirus (HPV) vaccine is one of the most cost-effective public health measures for preventing cervical cancer and other HPV-related diseases. However, the vaccine uptake in many countries remains suboptimal. This cross-sectional study aimed to assess the knowledge and awareness of parents towards HPV, related diseases, and HPV vaccines, as well as to examine the effect of brief educational information on parents' vaccine acceptability. We used a structured interviewer-administered questionnaire to collect information from 227 outpatient visitors to a healthcare center who had children under the age of 19years. We asked parents again about their acceptance of HPV vaccines after being provided brief educational information. Of all the parents, 43% were aware of HPV and related diseases, and 59% of those had sufficient knowledge regarding HPV while 45% of them reported that they were aware of HPV vaccines. Being Northern Cypriot was a predictor of having good knowledge, whilst being a female, having a higher education level, being 35years or older, and being employed were the significant predictors of having greater awareness of HPV and related diseases. The HPV vaccine acceptance of the parents increased substantially in all sociodemographic groups after the provision of the educational information. The findings demonstrated that the vaccination rates of children of parents who have insufficient knowledge and awareness of HPV and vaccines are also very low. Effective educational interventions based on the specific sociodemographic characteristics of the patients should be given a stronger focus to improve vaccine acceptability among this population.

Assessment of Factors Associated with Dropout for Pentavalent Vaccine in Tertiary Care Hospital of Kathmandu, Nepal

Immunization is one of the most cost-effective public health measures as it has helped in huge reduction of disease, disability and death from different infectious diseases in children by protecting them from vaccine preventable diseases. The current study aimed to study factors associated with dropout for pentavalent vaccine in tertiary care hospital of Kathmandu. A longitudinal observational study using purposive sampling technique was conducted among 196 infants. The information was obtained using self-constructed structured questionnaire from parents visiting Community Medicine OPD of Nepal Medical College Teaching Hospital. The information regarding socioeconomic characteristics of mother, gender of the infant, place of delivery of child, birth order and reasons for dropout of pentavalent third dose were taken. The dropout of third dose pentavalent vaccine was mainly seen in infant of parents living in rented house and according to gender wise, dropout was high among male infants. The different reasons for dropout of vaccine were busy parents, forgotten date, visit to other immunization centres and sick infants. Among these, the main reason for dropout of vaccine was due to infants getting sick during the time of immunization. The dropout rates between first and third dose of pentavalent vaccine were 26.3% and 30.4% respectively for two consecutive months and the overall dropout rate was 28.35%. Also, literacy level of the mother was directly associated with the immunization visit of the infant as, maximum number of infants of illiterate mother were absent for third dose of pentavalent vaccine as opposed to no absentee among master degree holding mothers. Thus, the present study provides valuable information regarding the factors associated with dropout for pentavalent vaccine.

21.H. Workshop: Incentivising vaccination uptake in Europe

Abstract Vaccination is the main tool for primary prevention of disease and one of the most cost-effective public health measures available. Immunisation through vaccination is the best defence we have against serious, preventable, and sometimes deadly, contagious diseases. However, we have witnessed measles outbreaks in the last years that could have been avoided if vaccination rates had been sufficiently high. The vaccination rate against seasonal influenza for older people also remains much below the recommended level (75%) in most EU countries. We have also seen countries taking policy measures, such as introducing mandatory vaccination against certain childhood diseases (France, Italy, Germany), while other countries retain high vaccination rates without establishing such measures (e.g. Sweden, Denmark, Portugal). This session will bring together policy-makers at various levels (national, regional), experts and civil society (e.g. health care professional associations) to showcase recent policy initiatives, good practices and innovative collaborations aiming at increasing the vaccination rates for key vaccines and taking a life course approach. Key messages Vaccination is the main tool for primary prevention of disease and one of the most cost-effective public health measures available. Immunisation through vaccination is the best defense we have against serious, preventable, and sometimes deadly, contagious diseases.

Incuding behavioral determinants of vaccine demand and acceptance in the EU policy-making process

Abstract Vaccination is one of the most powerful and cost-effective public health measures developed in the 20th century, and remains the main tool for primary prevention of communicable diseases. Yet, in spite of the overall benefits of vaccination, a number of key challenges still remain to ensure sustainable, equitable and effective vaccination programmes in all EU Member States, and to secure that the added benefits of vaccinations are not lost. The overall purpose of the research programme presented is to facilitate and execute research on vaccine confidence, identifying behavioural determinants of vaccine hesitancy across different subgroups of the population (including disadvantaged and socially excluded groups) and healthcare workers, for specific categories of vaccines in a number of Member States of the European Union (MS of EU). The research group has facilitated and executed a preliminary research (consisting of a set of focus groups and an experimental survey) on vaccine confidence, for specific categories of vaccines in a number of MS of EU (Spain, Portugal, Romania, Italy, Poland, French). The outcome of the preliminary study will support the identification of the most promising areas of implementation of behavioural insights to improve vaccine confidence. At the time of writing of this abstract, the results are under collection, and will be ready by the end of June 2020. During the policy design and preparation phase, supported by a behavioural mixed methodology study, a number of behavioural determinants of vaccination demand and acceptance have been identified. This is crucial for policy making at the EU level, especially since the principle of subsidiary limits the possibilities for direct EU action over choice architecture. This requires further coordination with national health authorities Key messages During the policy design and preparation phase, supported by a behavioural mixed methodology study, a number of behavioural determinants of vaccination demand and acceptance have been identified. In the policymaking at EU level, including behavioural insight at the design and preparation stage is crucial for effective delivery of policy objectives.

Bacteria-like particle bead complexes as an immunostimulatory platform for high-throughput vaccine antigen capture and delivery

Abstract Vaccines are cited as the most cost-effective public health measure in controlling infectious diseases. Scalable and high-throughput platforms can accelerate vaccine discovery, which reduces the burden on human life, morbidity and health system resources. To expedite the antigen identification and production process during the first steps of vaccine development, we have developed a highly efficient bead capture system that allows for rapid antigen capture and delivery. This technology can be used in conjunction with protein microarrays to swiftly screen and identify antigens as potential vaccine candidates. Model antigens from Coxiella burnetii, a known biothreat and the etiological agent of Q fever, were chosen based on previous protein microarray data and expressed from plasmids containing a His-tag in a cell-free expression system. To demonstrate proof-of-concept, we used polystyrene beads with tris-NTA linkers to capture antigens from the mixture. The resulting antigen-conjugated beads were administered directly to C57BL/6 mice individually, multiplexed, and/or with an adjuvant cocktail of MPLA/CpG/squalene-in-water emulsion. Sera collected at regular intervals were screened against protein microarrays to monitor the dynamics and isotypes of the antibody response. Cytokine levels were assessed in antigen recall assays on splenocyte cell cultures through ELISPOT or by bead-based cytometric assay. Here we observed robust, durable and antigen-specific T cell and antibody responses. IgG isotypes and cytokine levels revealed that including adjuvants tuned the Th1/Th2 responses to a balanced profile. In vitro studies are currently underway to determine antibody functionality and neutralization potential.

Overweight and obesity among school-going adolescents in Bengaluru, South India

Introduction: Adolescent obesity is an emerging public health problem in urban India. This study assessed the prevalence of overweight and obesity and its associated factors among school-going adolescents in Bengaluru, India. Material and Methods: Cross-sectional study of 734 male and female students aged 10 years and older from two private schools in Bengaluru city, India. Students were administered a questionnaire that recorded socioeconomic, and family-related factors and lifestyle behaviors. Anthropometric measurements done to determine overweight and obesity using the WHO body mass index for age charts. Nominal variables were described in terms of frequency and proportion, and odd's ratio (OR) (with 95% confidence interval) as test of association. Results: The prevalence of overweight and obesity among adolescents was 21.7% and 6.1% respectively. Age, gender, religion, education level of parents, mother working outside the home, participation in vigorous physical activities, vegetarian diet, and consumption of junk foods as snacks were not found to be significantly associated with overweight/obesity. Conclusion: The prevalence of overweight/obesity among school-going adolescents in Bengaluru, India was 27.8%. Adolescents from the higher income families, OR = 2.35 (1.43–3.85) as well as students who indicated a family history of obesity, OR = 2.4 (1.72–3.33) were more likely to be overweight or obese. Since young adolescents spend a significant portion of their day in school, a comprehensive school health service including growth monitoring, nutrition education, and exercise programs remains one of the most cost-effective public health measures.

Introduction of pneumococcal vaccine in national immunisation schedule in India: boon or bane?

Vaccination is undoubtedly one of the most cost-effective child survival public health measure which are more affordable and accessible to community in preventing diseases. Government of India has undertaken several initiatives to strengthen maternal and child health services in the country and child immunisation being an important part of child healthcare system in India. The National Immunization Programme has taken many initiatives since its inception as Expanded Programme on Immunization in 1978. In recent years, there has been introduction of various newer vaccines. Introduction of pneumococcal vaccine in selected states in year 2017 and plan to scale up in the entire country is the newest change in National Immunization Schedule. This review aims to identify various articles related to pneumococcal infection and vaccine highlighting the burden, serotypic distribution, available vaccines, evidence regarding vaccine safety, efficacy, acceptability and cost effectiveness, in order to provide sufficient understanding on the demand and need of this vaccine in India. Important factors underpinned by this article are though there is a need of vaccination due to severe form of pneumococcal infections and antibiotic resistance due to which many developed countries have included PCV in their regular immunisation programmes, however studies regarding effectiveness of pneumococcal vaccines in developing countries like India, data regarding the burden of pneumococcal infections are not available. Also there are limited studies investigating the bacterial and viral etiology of Community Acquired Pneumonia and lack of data to show change in the serotype prevalence overtime. This review highlights the need of more research to provide substantial clinical and epidemiological evidence for the introduction of pneumococcal vaccine.

Recent European Union (EU) initiatives to support national vaccination efforts

Abstract Background Vaccination is the main tool for primary prevention of disease and one of the most cost-effective public health measures available. Immunisation through vaccination is the best defence we have against serious, preventable, and sometimes deadly, contagious diseases. Thanks to widespread vaccination, smallpox has been eradicated, Europe made polio-free, and many other diseases almost eliminated. Methods This presentation provides an overview of recent European Union (EU) initiatives to support national vaccination efforts. Results The EU has launched a number of initiatives to strengthen national vaccination efforts. In December 2018 the European Council adopted a Recommendation to strengthen the EU cooperation on vaccine-preventable diseases. The initiative aims to tackle vaccine hesitancy, improve coordination on vaccine procurement, support research and innovation, and strengthen EU cooperation on vaccine-preventable diseases. EU countries are encouraged to develop and implement national vaccination plans with initiatives to improve coverage, and to introduce routine vaccination status checks. The European Commission is also reinforcing its support to national vaccination efforts to increase coverage, including through the preparation of a Joint Action on vaccination co-funded by the Health Programme. Launching in 2018, the Joint Action will address vaccine hesitancy and seek to increase vaccination coverage in the EU. It is coordinated by INSERM (France) and involves 23 countries (among them 20 EU countries). Conclusions Vaccination policy is a competence of national authorities, but the European Commission assists EU countries in coordinating their policies and programmes.

May Measurement Month 2017: an analysis of blood pressure screening in the Philippines-South-East Asia and Australasia.

Cardiovascular diseases remain the Philippines’ leading cause of mortality, with hypertension as a prevalent contributory risk factor. We took part in May Measurement Month 2017 (MMM17), a global initiative to raise awareness of high blood pressure (BP) and to serve as a temporary solution to the lack of screening programs worldwide. Following the standard MMM protocol, data for 271 604 screened individuals were submitted from the Philippines. After multiple imputation, 91 994 (34.3%) were hypertensive; 28 662 out of 205 158 participants (14.0%) not receiving treatment had hypertension; and of the 60 370 receiving treatment, 25 144 (41.6%) had uncontrolled BP. Blood pressures were significantly higher in the overweight and obese, current smokers, in participants receiving antihypertensive medication, those with previous myocardial infarction or stroke. The BP measurements were relatively lower when taken on the left arm, and in pregnant women. A slightly higher systolic BP was noted in participants who reported no alcohol intake. Blood pressures recorded during the weekends were highest, and the lowest readings were obtained on Tuesdays. MMM17 was the largest BP screening campaign conducted in the Philippines. Opportunistic BP screening, harnessing volunteers, are a cost-effective public health measure to improve awareness and treatment rates of raised BP. These may help provide additional information that can guide medical practitioners and health officials in drafting preventive and therapeutic measures to improve control rates and long-term outcomes of hypertensive individuals in the population.