Expanded Program Of Immunization Research Articles

Vaccine coverage rate: opportunities and challenges in managing the expanded program on immunization

Background: This study aims to determine the vaccine coverage rate in the expanded immunization program of children born from 2016-2020 through periods with and without the impact of the COVID-19 pandemic. Methods: The retrospective cross-sectional study with data, taken from the National Immunization Information System at two points of time (January 2021 and September 2022), was conducted on all children born from 2016 to 2020 with registered addresses in Ho Chi Minh City. Results: There are 3,1% of the population from other provinces entering Ho Chi Minh City and 1,8% of Ho Chi Minh City's population leaving the city. The overall fully vaccinated rate of children from 2016 to 2020 is 86,9%. The second measles coverage rate and diphtheria pertussis tetanus 4th dose (DPT4) coverage rate for children born in 2016-2020 was 78,1% and 72,4%. The DPT4 missed dose rate increased from 14,2% to 24,6% and the second measles missed shot rate increased from 8,9% to 19,5%. Under the impact of the COVID-19 pandemic, the vaccination coverage rate by age group decreased during the COVID-19 epidemic stages. After the epidemic, it recovered but the rate was not high. Conclude: There was a fluctuation in HCM population when retrospectively examining data at 2 points of time. The rate of vaccination coverage of children under and over 1 year old does not meet the target. The missed dose percentage of vaccines for children under 1 year old is low (diphtheria pertussis tetanus 1st dose (DPT1)-measles 1 or DPT1-3), while the proportion of missed is high in DPT3-DPT4 and Measles 1-Measles 2. The retrospective cross-sectional study only used retrospective data up to September 2022, so it is hard to illustrate a clear recovery after the COVID-19 pandemic. More time is needed for the observation.

The Scourge of Poliomyelitis in Pakistan: Barrier towards its eradication.

Poliomyelitis is an extremely disabling disease caused bythe polio virus, a virus belonging to Picornaviridae family.Humans are the only natural host. The virus principallyinvolves the motor neurons resulting in permanentasymmetrical lifelong paralysis. Effective vaccines areavailable for its eradication. Unfortunately despite vaccineavailability the disease cannot be eradicated from earth yet.Pakistan and Afghanistan are the only two nationsharbouring the polio virus. Lately sporadic cases ofPoliomyelitis have also been reported from countries likeMozambique, which had an outbreak following importingof wild poliovirus (WPV1) from Pakistan.1 As long as a singlechild remains infected, children in all countries are at riskof contracting polio.2 Expanded Programme for Immunization (EPI) was initiatedin Pakistan in 1978. Polio vaccine was included along withfive other vaccines against life threatening diseases likeTuberculosis, Diphtheria, Pertussis, Tetanus, and Measles.The journey that took off smoothly with over 50% vaccinecoverage by 1990 raised to 80% coverage by 2007, hastaken a sharp dip in the ensuing decades. Pakistanunfortunately never recovered from the scourge of poliodisease. In 1988 Global Polio Eradication Initiative (GPEI)was started, that resulted in a decline to 99% cases of polioin the world, but Pakistan continued to face challengeswhich has prevented total eradication of polio.3 Continued...

Genetic characteristic of mumps virus from 2012 to 2016 and its serum antibody level among general healthy population during 2018–2020 in Jiangsu Province, China

Mumps is a vaccine-preventable disease with high contagious capability. Its incidence declined rapidly since one dose of mumps vaccine was introduced into Expanded Program of Immunization (EPI) in 2008 in China. Nonetheless, the outbreaks of mumps remain frequent in China. Here we aim to assess herd immunity level followed by one-dose mumps ingredient vaccine and to elucidate the genetic characteristics of mumps viruses circulating in the post vaccine era in Jiangsu province of China. The complete sequences of mumps virus small hydrophobic(SH) gene were amplified and sequenced; coalescent-based Bayesian method was used to perform phylogenetic analysis with BEAST 1.84 software. Commercially available indirect enzyme-linked immune-sorbent IgG assay was used for the quantitative detection of IgG antibody against mumps virus. Our results show that genotype F was the predominant mumps viruses and belonged to indigenous spread, and most of Jiangsu sequences clustered together and formed a monophyly. The prevalence of mumps reached a peak in 2012 and subsequently declined, which presented an obvious different trajectory with virus circulating in other regions of China. The gene diversity of viruses circulating in Jiangsu province was far less than those in China. The antibody prevalence reached 70.42% in the general population during 2018 to 2020. The rising trend of antibody level was also observed. Although mumps antibody prevalence does not reach expected level, mumps virus faces higher pressure in Jiangsu province than the whole of China. To reduce further the prevalence of mumps viruses, two doses of mumps vaccine should be involved into EPI.

Determinants of pneumococcal vaccination dropout among children aged 12-23 months in Ethiopia: a secondary analysis from the 2019 mini demographic and health survey.

Vaccination is a cost-effective public health program that helps reduce significant morbidity and mortality in children under the age of five. Worldwide, the number of vaccine-preventable causes of child death has significantly decreased since the Expanded Program of Immunization (EPI) was introduced. However, for a variety of reasons, 23 million children did not have adequate access to vaccines in 2020. Therefore, this study aimed to evaluate the determinants of pneumonia conjugate vaccine (PCV) dropout among children aged 12-23 months in Ethiopia. The study analyzed cross-sectional data obtained from the 2019 mini Ethiopian demographic and health survey. Multilevel binary logistic regression analysis was utilized, and the best fit model was chosen using the Akaike Information Criteria. The study comprised a weighted sample of 989 children aged 12 to 23 months. The study presented the Adjusted Odds Ratio (AOR) along with a 95% Confidence Interval (CI) to identify the significant factors influencing PCV dropout. The PCV dropout rate was reported at 20.2% in this study. In the multilevel analysis, possession of a health card (AOR = 0.076, 95% CI: 0.019, 0.04), vaccination for PCV 2 (AOR =0.002, 95% CI: 0.023, 0.263), and region 7 (AOR = 6.98, 95% CI: 10.1, 48.31) were significantly associated with children's PCV dropout. Having a health card, having received the PCV 2 vaccinations, and region were significant predictors of PCV dropout. Consequently, health education on immunization for all mothers and region-specific, customized public health interventions are needed to reduce the vaccination dropout rate.

Vaccination and Immunization as Perceived by Badjao Parents in Surigao City, Philippines

Health authorities in the Philippines are tackling emerging infectious diseases among Filipino children by implementing precautionary measures, with a focus on strengthening immune systems. The cornerstone of their efforts is the 40-year-old Expanded Immunization Program (EPI), a key initiative by the Department of Health. This descriptive quantitative study aimed to inspire provision for Filipino children with safe vaccinations, addressing diseases like measles, diphtheria, tetanus, and whooping cough. The EPI has significantly reduced death and morbidity rates associated with preventable diseases. This study delves into the knowledge, attitudes, beliefs, and confidence among Badjao parents in Barangay Canlanipa, Surigao City, regarding children’s vaccination and immunization. The methodology included the utilization of researcher-made questionnaires and statistical tools such as the Frequency Count and Percentage, Mean and Standard Deviation, and Chi-Square Test. The study highlighted that despite challenges such as limited education and socioeconomic factors, many Badjao parents prioritized their children’s vaccination and immunization. However, the study revealed disparities in knowledge and confidence levels, emphasizing the need for targeted information campaigns. The study recommends targeted programs to promote the EPI’s benefits among the Badjao community and urges health authorities to conduct information drives. It also suggests exploring how personal experiences, like family illnesses, affect vaccination decisions. The study ultimately provides valuable insights for local stakeholders, healthcare providers, and future researchers, highlighting the importance of vaccination and immunization for children’s health.

Evaluation of IgG antibody response to diphtheria toxin one month after tetanusdiphtheria vaccination among 7-years-old children in a mountainous district in the Northern region of Viet Nam in 2020

Under the outbreak of diphtheria disease mostly among preschool and primary school children, following the recommendations of WHO, Vietnam has implemented a second booster dose of diphtheria vaccine since 2019 for children at 7 years old in some at-risk provinces. This study evaluated the IgG antibody response to diphtheria toxid in a group of 7-year-old children living in Tran Yen district, Yen Bai province, after receiving one dose of Tetanus-diphtheria (Td) vaccine with reduced diphtheria toxoid in 2020. The study involved community intervention, monitoring 98 7 yearold children who received the Td vaccine to compare the proportion of children with a full protective antibody level (antibody concentration ≥ 0.1IU/mL) before and one month after vaccination. The results showed that the proportion of children with a protective antibody level against diphtheria toxin increased from 35% to 95% one month after vaccination. The intervention coefficient was 171%. 80% of children achieved long-term protective antibody levels (≥ 1.0IU/mL). The Td vaccine helped children achieve full and long-term protective antibody levels, even in those without the complete primary vaccination series and those with only baseline or no protection levels. Vaccinating 7-year-old children in areas with limited vaccination coverage and no actual circulating diphtheria cases is effective and necessary to prevent disease outbreaks. The study’s results suggest the Ministry of Health should consider including the Td vaccine in the Expanded Immunization Program for regular vaccination for 7-year-old children instead of approving current annual plans.

The role of new hepatitis B vaccines in South Africa.

Vaccination is key to eliminating hepatitis B virus infection in South Africa (SA). Despite introducing immunisation in 1995, as part of the expanded programme of immunisation (EPI), hepatitis B virus infection remains endemic, and EPI vaccine coverage is incomplete. In addition to infants, non-immune adults at risk of infection through their occupation or with behavioural risk factors should receive vaccination. SA has many individuals with diabetes mellitus (a prevalence of almost 13%), obesity, HIV (8.45 million) or older age (5 million >60 years old), associated with a poorer vaccine response. Recently two new hepatitis B vaccines have been licensed: HEPLISAV-B includes an adjuvant that improves immunogenicity and has shown improved vaccine response in individuals with HIV, old age or diabetes mellitus. PreHevbrio, which includes three hepatitis B surface protein domains, instead of one, may also be more immunogenic, although clinical study data are still limited. These two novel vaccines have not yet been investigated in children and licensed in SA. Should HEPLISAV-B become available in SA, it may be particularly valuable to target high-risk groups in the country, such as people living with HIV, who show a poor response to the currently licensed vaccine.

Pandemic disruptions in vaccine uptake in a low-income setting: a qualitative inquiry

BackgroundWhile the COVID-19 pandemic has exposed the vulnerabilities of immunization delivery systems globally, the devastating impact of the pandemic on immunization delivery is most pronounced in low and middle-income countries like Pakistan. We conducted a qualitative study to capture the views and experiences of parents and healthcare workers (HWs) and assess the impact of the COVID-19 pandemic on childhood routine immunization (CRI) and COVID-19 vaccination in Pakistan.MethodsWe used a qualitative research design with a purposive sampling approach. Semi-structured interviews (via telephone) and focus group discussions (via Zoom) were conducted with parents/child caregivers and HWs, respectively. All qualitative interviews were conducted between February and July 2021 from three sites (two urban and one rural) in Sindh, Pakistan. Interviews were audio-recorded, transcribed, and coded for a team-based thematic analysis.ResultsOverall, most parents and HWs indicated a strong trust in the benefits of CRI; nonetheless, a substantial disruption in the delivery and uptake of these services was also reported. The barriers towards CRI included closed vaccination centers, drastic reduction in outreach programs, lack of information for parents/child caregivers on vaccine availability, fear in the community regarding vaccine safety, limited vaccine supply, and a lack of healthcare staff. For COVID-19 vaccines, challenges cited included skepticism about the reality of the pandemic and confusion over COVID-19 vaccines due to conflicting (or mis-or-dis) information. Both participant groups showed a willingness to integrate COVID-19 vaccination into Pakistan’s Expanded Program for Immunization if required in the future.ConclusionDuring the COVID-19 pandemic, disruptions of regular immunization delivery in Pakistan were not due to parental unwillingness to vaccinate, but rather to social and logistical challenges caused by a rapidly changing context and difficulties in providing vaccination services safely. Barriers to vaccine access and concerns about COVID-19 exposure during clinic visits also contributed to uncertainty regarding immunization services early in the pandemic. For catchup campaigns and future pandemics, more than focusing interventions on persuading people, strategic approaches to building resilience through system-based interventions, such as investing in surge capacity in the immunization workforce to bounce back quickly after the first shock are required.

Assessment of immunization data management practices in Cameroon: unveiling potential barriers to immunization data quality

BackgroundOne crucial obstacle to attaining universal immunization coverage in Sub-Saharan Africa is the paucity of timely and high-quality data. This challenge, in part, stems from the fact that many frontline immunization staff in this part of the world are commonly overburdened with multiple data-related responsibilities that often compete with their clinical tasks, which in turn could affect their data collection practices. This study assessed the data management practices of immunization staff and unveiled potential barriers impacting immunization data quality in Cameroon.MethodsA descriptive cross-sectional study was conducted, involving health districts and health facilities in all 10 regions in Cameroon selected by a multi-stage sampling scheme. Structured questionnaires and observation checklists were used to collect data from Expanded Program of Immunization (EPI) staff, and data were analyzed using STATA VERSION 13.0 (StataCorp LP. 2015. College Station, TX).ResultsA total of 265 facilities in 68 health districts were assessed. There was limited availability of some data recording tools like vaccination cards (43%), maintenance registers (8%), and stock cards (57%) in most health facilities. Core data collection tools were incompletely filled in a significant proportion of facilities (37% for registers and 81% for tally sheets). Almost every health facility (89%) did not adhere to the recommendation of filling tally sheets during vaccination; the filling was instead done either before (51% of facilities) or after (25% of facilities) vaccinating several children. Moreso, about 8% of facilities did not collect data on vaccine administration. About a third of facilities did not collect data on stock levels (35%), vaccine storage temperatures (21%), and vaccine wastage (39%).ConclusionOur findings unveil important gaps in data collection practices at the facility level that could adversely affect Cameroon’s immunization data quality. It highlights the urgent need for systematic capacity building of frontline immunization staff on data management capacity, standardizing data management processes, and building systems that ensure constant availability of data recording tools at the facility level.

THE STATUS AND SOME FACTORS RELATED TO SAFE IMMUNIZATION PRACTICE AT COMMUNAL-WARD ADMINISTRATIVE UNITS IN PHU YEN PROVINCE IN 2022

Vaccines are preparations containing antigens that are introduced into the body to create an immune response. Therefore, the review of safe vaccination practice (TCAT) in immunization sessions at commune and ward health stations and some related factors is a very necessary and urgent issue to improve the quality of vaccination. Cross-sectional descriptive study design at 20 health stations of Phu Yen province. Results: 100% of health stations meet TCAT requirements during vaccination sessions ; 85.1% of children were trained in the satisfactory injection procedure, the reception and screening procedures and the post-injection follow-up met the requirements of 82.9% and 83.4%, respectively. There are 73.1% of children who have successfully practiced the pre-vaccination counseling process. The analysis results show that a number of factors are related to TCAT implementation, such as staff in charge of the expanded immunization program, medical qualifications, and doctors' qualifications . Besides, injection team with satisfactory general knowledge performed TCAT better than injection team with unsatisfactory general knowledge. Therefore, strengthen supervision and professional training related to vaccination practices of health workers.

Evaluating the "Zindagi Mehfooz" Electronic Immunization Registry and Suite of Digital Health Interventions to Improve the Coverage and Timeliness of Immunization Services in Sindh, Pakistan: Mixed Methods Study.

The Zindagi Mehfooz (safe life; ZM) electronic immunization registry (EIR) is a comprehensive suite of digital health interventions that aims to improve equitable access, timeliness, and coverage of child immunizations through a smartphone-based app for vaccinators, web-based dashboards for supervisors and managers, text message alerts and reminders for caregivers, and a call center. It has been implemented at scale in Sindh Province, Pakistan. This study aimed to present findings from an evaluation of the ZM-EIR suite of digital health interventions in order to improve data availability and use as a contribution, among other immunization program interventions, to enhanced immunization outcomes for children aged 12-23 months in Sindh Province. The mixed methods study included (1) analysis of ZM-EIR system data to identify high-, moderate-, and low-adoption and compliance sites; (2) in-depth interviews with caregivers, vaccinators, supervisors, and managers in the Expanded Program for Immunization (EPI); and (3) pre-post outcome evaluation using vaccine coverage from the Multiple Indicator Cluster Surveys (MICS) 2014 and 2018-2019. Key outcomes of interest were improved data availability, use and contribution to immunization outcomes, including receipt of individual antigens (Bacillus Calmette-Guérin [BCG], pentavalent [Penta] 1-3, measles), full immunization (all antigens), and zero-dose children defined as children aged 6-23 months who have not received the first dosage of the diphtheria-pertussis-tetanus 1/Penta vaccine. By registering newborns, providing alerts and reminders, and tracking their immunization completion, the ZM-EIR improved data availability and use in the EPI. The ZM-EIR was well received by EPI administrators, supervisors, vaccinators, and caregivers. The key benefit highlighted by ZM-EIR users was a list of children who missed scheduled vaccines (defaulters). Through greater availability and use of data, the ZM-EIR implementation, as part of a broader package of immunization program-strengthening activities in Sindh Province, may have contributed to an increase in immunization coverage and timeliness for BCG vaccinations and a decrease in zero-dose children in 2018-2019 from 2014. Additional findings from the study included the dual burden of reporting on paper and gender-related considerations of female caregivers not wanting to provide their phone numbers to male vaccinators, creating barriers to greater uptake of the ZM-EIR. The ZM-EIR is a promising technology platform that has increased the availability and use of immunization data, which may have contributed, along with other intensive immunization program interventions, to improvements in immunization outcomes through systematic registration of children, alerts and reminders, and increased use of data for planning and monitoring by the EPI. ISRCTN Registry ISRCTN23078223; https://doi.org/10.1186/ISRCTN23078223.

Effect of COVID-19 on immunization coverage of children aged 0-11 months in the center region of Cameroon.

The occurrence of epidemics is known to contribute in reducing the capacity of health facilities to deliver care and the predisposition of populations to seek care through several mechanisms. The objective was to assess the effect of the COVID-19 on vaccination coverage of the expanded program of immunization (EPI) vaccines in children aged 0-11 months. The study involved a descriptive and case control designs exhaustively targeting health facilities in health areas from selected health districts. The descriptive part explored the distribution of immunization coverage 12 months before and during COVID-19. Data were extracted from monthly EPI reports of health areas. Cases were months with immunization coverages of Bacille Calmette-Guerin (BCG), Measles Mumps-Rubella 1 (MMR1) or Diphtheria-Pertussis-Tetanus Hepatitis B + Hemophilus influenzae type b dose 3 (DPT-Hi+Hb3) less than 80%. The exposure were months belonging to the pandemic period. Of the 78 targeted health areas, 74 (94.87%) were reached. The monthly immunization coverage of BCG, RR1, DPT-Hi+Hb 1 and 3 decreased during the pandemic period by minimum 30%. Being a health-area month belonging to the COVID-19 pandemic period was found to be significantly associated to lower BCG [OR=2.00 (1.61; 2.50); P#x003C;0.001], MMR1 [OR=2.45 (1.76; 3.41); P#x003C;0.001] and DPT-Hi+Hb3 [OR=2.11 (1.68; 2.640); P#x003C;0.001] immunisation coverage. COVID-19 had a significant effect on the decrease of immunization coverages of antigens offered in the EPI program. This raises the need to develop interventions during health emergencies to prevent disruption of health services access.

Eliminating Vertical Transmission of HIV in South Africa: Establishing a Baseline for the Global Alliance to End AIDS in Children.

To gain a detailed overview of vertical transmission in South Africa, we describe insights from the triangulation of data sources used to monitor the national HIV program. HIV PCR results from the National Health Laboratory Service (NHLS) were analysed from the National Institute of Communicable Diseases (NICD) data warehouse to describe HIV testing coverage and positivity among children <2 years old from 2017-2021. NICD data were compared and triangulated with the District Health Information System (DHIS) and the Thembisa 4.6 model. For 2021, Thembisa estimates a third of children living with HIV go undiagnosed, with NICD and DHIS data indicating low HIV testing coverage at 6 months (49%) and 18 months (33%) of age, respectively. As immunisation coverage is reported at 84% and 66% at these time points, better integration of HIV testing services within the Expanded Programme for Immunization is likely to yield improved case findings. Thembisa projects a gradual decrease in vertical transmission to 450 cases per 100,000 live births by 2030. Unless major advances and strengthening of maternal and child health services, including HIV prevention, diagnosis, and care, can be achieved, the goal to end AIDS in children by 2030 in South Africa is unlikely to be realised.

Impact of Breast Feeding On Diarrhea and Pneumonia Among Vaccinated Children: Single Center Study

The best way to give babies the nutrition they need to grow and develop is through breast milk. Objective: To assess the combine effect of breast feeding, Rota virus vaccine and Pneumococcal vaccine on frequency of Diarrhea and Pneumonia in children less than 5 years of age. Methods: A descriptive cross-sectional study conducted at Department of Pediatrics at Darul sehat hospital, Karachi. Participants were selected by convenience sampling and interview-based questionnaire was used. 196 Participants were interviewed which included mothers of infant and children from 6 months to 5 years of age, who received complete or partial vaccination according to Expanded program of Immunization (EPI) schedule with information on history of diarrhea and pneumonia. Infant and children with bloody diarrhea were excluded. Results: Among the 196 participants, 152 (77.6%) children received breast feed,72(47.4%) children received two doses of Rota vaccine and 128 (84.2%) children received three doses of Pneumococcal vaccines. Significant impact was seen with breast feeding and Rota vaccine on the frequency of diarrhea with p value of 0.0001. Breastfeeding and the pneumococcal vaccine both had a similar potent effect on the prevalence of pneumonia, with a p-value of 0.006. Conclusions: Our study highlights the importance of breast feeding in vaccinated children, with incidence of diarrhea in breastfed, vaccinated children decreased to (32%), compared to 93% in non-breastfed, unvaccinated infants. Similarly, only 33% of breastfed, vaccinated children developed pneumonia, compared to 85% of unvaccinated, non-breastfed infants.

Missed opportunities for immunization among children 0 to 11 months of age that were attended to at debre tabor comprehensive specialized hospital, south gondar zone, Ethiopia.

The World Health Organization's Expanded Immunization Program was established in 1974 and aimed to provide vaccines to children all over the world. Since the inception of this program, numerous initiatives and campaigns have been launched, and millions of children around the world have been saved from death. Many vaccine-preventable diseases, however, remain prevalent in developing countries. This is because most of those countries have low immunization coverage for an unknown number of reasons. As a result, the goal of this study was to examine missed opportunities for immunization among children aged 0 to 11 months. A cross-sectional survey was carried out from May to August 2022. A structured questionnaire was used to collect data, and the sample was chosen using a simple random sampling technique. Before being entered into the Epidata and exported to the Statistical Package for Social Science for analysis, the data were checked for consistency and completeness. The statistical significance was determined using binary and multiple logistic regression analyses. The statistical level of significance was established at p ≤ 0.05. In this study, 49.1% of immunization opportunities were missed. Education status [AOR = 2.45, 95% CI = 2.14, 4.22], rural residence [AOR = 4.32, 95% CI = 3.11, 6.38], and perception of caretakers [AOR = 2.13, 95% CI = 1.89, 4.07] were associated with the missed opportunity of immunization. When compared to previous studies, the proportion of missed immunization opportunities was high in this study. The healthcare staff should be applying the multi-dose vial policy, which is recommended by the World Health Organization to increase the services. The doses for BCG and measles should be minimized to lower doses per vial in order to conduct immunization without having to wait for enough children and without worrying about vaccine waste. All infants who visit the hospital should be linked to immunization services.

Prevalence and Risk Factors of Hepatitis B Virus in a Population of Children and Teenagers in Ebolowa, Cameroon: A Community-Based Study

Background: This study aimed at determining the prevalence of hepatitis B virus (HBV) infection as well as risk factors associated with the infection in infants born after the introduction of the hepatitis B vaccine in the expanded program of immunization (EPI) in Cameroon. Patients and Method: It was a cross sectional prospective community-based study hosted in the premises of the Ebolowa regional hospital from August to October 2019. All participants who met our selection criteria were enrolled. Demographic data, risk factors and HBsAg results were analyzed using the CS-Pro software. P-values less than 5% were considered significant on univariate analysis. Results: A total of 208 participants with a mean age of 8.9 (± 3.4) years old were enrolled in the study, 53.8% of whom were male. The overall HBsAg prevalence was 1.9% (95% CI : 0.5 – 3.8), with no infection recorded among those aged between 10 to 14 years old. All those infected were at most in primary school. Upon univariate analysis, there was no significant association between hepatitis B virus infection and past history of surgery, blood transfusion, scarifications, tattooing, piercing, jaundice and family history of hepatitis B virus. As a matter of facts none of the infected infants had a past history of surgery, blood transfusion, jaundice, tattooing nor piercing. Conclusion: The prevalence of HBV was 1.9%. Policies must be put in place to stop new infections as well as adequately following up infected infants.

Lessons Learned and Future Perspectives for Rotavirus Vaccines Switch in the World Health Organization, Regional Office for Africa.

Following the World Health Organization (WHO) recommendation, 38/47 countries have introduced rotavirus vaccines into the program of immunization in the WHO Regional Office for Africa (WHO/AFRO). Initially, two vaccines (Rotarix and Rotateq) were recommended and recently two additional vaccines (Rotavac and Rotasiil) have become available. However, the global supply challenges have increasingly forced some countries in Africa to switch vaccine products. Therefore, the recent WHO pre-qualified vaccines (Rotavac, Rotasiil) manufactured in India, offer alternatives and reduce global supply challenges related to rotavirus vaccines; Methods: Using a questionnaire, we administered to the Program Managers, Expanded Program for Immunization, we collected data on vaccine introduction and vaccine switch and the key drivers of the decisions for switching vaccines products, in the WHO/AFRO. Data was also collected fromliterature review and the global new vaccine introduction status data base maintained by WHO and other agencies. Of the 38 countries that introduced the vaccine, 35 (92%) initially adopted Rotateq or Rotarix; and 23% (8/35) switched between products after rotavirus vaccine introduction to either Rotavac (n = 3), Rotasiil (n = 2) or Rotarix (n = 3). Three countries (Benin, Democratic Republic of Congo and Nigeria) introduced the rotavirus vaccines manufactured in India. The decision to either introduce or switch to the Indian vaccines was predominately driven by global supply challenges or supply shortage. The withdrawal of Rotateq from the African market, or cost-saving for countries that graduated or in transition from Gavi support was another reason to switch the vaccine; Conclusions: The recently WHO pre-qualified vaccines have offered the countries, opportunities to adopt these cost-effective products, particularly for countries that have graduated or transitioning from full Gavi support, to sustain the demand of vaccines products.

Influence of socio-cultural factors on hepatitis B infection in Mombasa County, Kenya

Background: The hepatitis B virus (HBV) is responsible for causing a communicable liver disease that can be prevented through vaccination. Although the HBV vaccine was introduced in Kenya’s expanded immunization program in 2003, the incidence of HBV remains high in the country, especially among IDUs. Objective was to investigate the influence of socio-cultural factors on HBV infection in Mombasa County, Kenya. Methods: The study utilized a cross-sectional analytical design. The study was purposely conducted in Mombasa County because the area is highly prevalent with drug users and people with hepatitis B. There are eight treatment centers in the county, 4 public and 4 privates where stratified random sampling was used. The sample size was proportionately distributed across the selected treatment centers. The study employed a mixed method of data collection, involved; self-administered questionnaire to the IDU’s, key informant interviews and focused group discussion with treatment care managers. Results: The prevalence of hepatitis B was 22%; with male (77.1%) most affected than women (22.9%). Bivariate analysis show that a history of drug abuse was significantly associated with prevalence of hepatitis B (χ2=2.485, df=1, p=0.046). Conclusions: The prevalence of hepatitis B is on the increase among injecting drug users. Having a history of drug abuse was a significant predictor to the prevalence of hepatitis B among injecting drug users in this study. Cultural practices such as piercing and tattooing were observed among study participants were established as a risk factor to hepatitis B infection among injecting drug users.

KNOWLEDGE OF HEALTHCARE PROVIDERS IN EXPANDED PROGRAM ON IMMUNIZATION, SA’ADAH, YEMEN

Background: After achieving high vaccination coverage, vaccine failure may occur. The sufficient knowledge of the workers in the expanded program of immunization (EPI) is one of the factors that affect in preventing this failure. In Saada, Yemen, there is no information about the knowledge of workers in the EPI. This study seeks to assess the knowledge of those in charge of immunization in Sa’adah, Yemen. Method: This prospective cross-sectional study was performed to assess healthcare providers (HCPs) knowledge regarding EPI. It was conducted on 60 HCPs in 60 H.F of 11 districts in Sa’adah Governorate, Yemen during 1 June – 30 July 2019. Appropriate interviewing pre-tested questionnaire was used to collect data from HCPs working in EPI. It includes the following: socio-demographic characteristics, knowledge about; cold chain and the method and time of administration of the vaccine and shake test. Face to face interview used to collect information. Data entering and cleaning were done using Microsoft Excel 2019 and exported to SPSS version 26, p-value less than 0.05 were considered significant. Differences in samples means were evaluated by chi-square test. Results: Age is one of the determining factors for knowledge of cold chain management (FET=0.040*), and the total knowledge score for of HCPs was (26.7%, 65%, and 8.3%) for good, fair, and poor knowledge, respectively. Conclusion: Only twenty-six-point seven of HCPs had a good knowledge score. Constant technical support and on job training to improve the HCPs knowledge about immunization are extremely recommended. Peer Review History: Received: 20 December 2022; Revised: 5 February 2023; Accepted: 3 March, Available online: 15 March 2023 Academic Editor: Dr. Emmanuel O. Olorunsola, Department of Pharmaceutics &amp; Pharmaceutical Technology, University of Uyo, Nigeria, olorunsolaeo@yahoo.com Received file: Reviewer's Comments: Average Peer review marks at initial stage: 5.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. Muhammad Zahid Iqbal, AIMST University, Malaysia, drmmziqbal@gmail.com Dr. Olanrewaju Rita-Marie Awotona, Legacy University, Banjul , The Gambia, olanrewajuadegbola@gmail.com Rola Jadallah, Arab American University, Palestine, rola@aauj.edu Similar Articles: TETANUS IMMUNIZATION AMONG PREGNANT WOMEN: COVERAGE RATE AND RATE OF PROTECTION AT TIME OF DELIVERY EVALUATION OF THE IMMUNE RESPONSE TO POLIO VACCINE IN MALNOURISHED CHILDREN IN SANA'A CITY

Frequency of Age-Appropriate Vaccination in Children Till 15 Months of Age Admitted at the Aga Khan Hospital, Karachi, Pakistan

Objective: To determine the frequency of age-appropriate vaccination till 15 months of age at Aga Khan Hospital, Karachi Pakistan. Study design: Cross-sectional study Place and Duration: Inpatient department of the Aga Khan University Hospital from Nov 2019 to Nov 2020 Methodology: All children admitted to the pediatric ward and fulfilling the inclusion criteria were enrolled. A predesigned proforma was used to collect data on the basic demographics of children and parents, their socioeconomic status, parental education, occupation, and vaccination status. The age-appropriate vaccination was defined as children who had received the vaccination, according to their age as per the expanded program of immunization (EPI) schedule of Pakistan. All collected data were analyzed using SPSS version 23. Results: Out of 350 admitted children, 222 (63.4%) were males and 128 (36.6%) were females. Most of the children were vaccinated (95.7%), while 4.3% were not vaccinated. Among vaccinated children, 63.7% had not received age-appropriate vaccination, and only 127 (36.3%) had age-appropriate vaccination. Statistically, the employment status of mothers (p=0.001) and educational level of mothers (p=0.001) and fathers (p=0.001) were significantly associated with age-appropriate vaccination in children of age up to 15 months. Conclusion: Despite having a high vaccination coverage rate, the proportion of age-appropriate vaccination was lower. The factors associated with age-appropriate vaccination were the employment status of the mother and the educational status of the parents. Vaccination programmes should work on identified risk factors in order to improve age-appropriate vaccination coverage. Keywords: Age appropriate vaccination, immunization, vaccination card