Immunization Efforts Research Articles

Public Health Strengths During the COVID-19 Response.

Public Health Strengths During the COVID-19 Response.

Primary Care's Historic Role in Vaccination and Potential Role in COVID-19 Immunization Programs.

Coronavirus disease 2019 (COVID-19) pandemic recovery will require a broad and coordinated effort for infection testing, immunity determination, and vaccination. With the advent of several COVID-19 vaccines, the dissemination and delivery of COVID-19 immunization across the nation is of concern. Previous immunization delivery patterns may reveal important components of a comprehensive and sustainable effort to immunize everyone in the nation. The delivery of vaccinations were enumerated by provider type using 2017 Medicare Part B Fee-For-Service data and the 2013-2017 Medical Expenditure Panel Survey. The delivery of these services was examined at the service, physician, and visit level. In 2017 Medicare Part B Fee-For-Service, primary care physicians provided the largest share of services for vaccinations (46%), followed closely by mass immunizers (45%), then nurse practitioners/physician assistants (NP/PAs) (5%). The Medical Expenditure Panel Survey showed that primary care physicians provided most clinical visits for vaccination (54% of all visits). Primary care physicians have played a crucial role in delivery of vaccinations to the US population, including the elderly, between 2012-2017. These findings indicate primary care practices may be a crucial element of vaccine counseling and delivery in the upcoming COVID-19 recovery and immunization efforts in the United States.

COVID-19 vaccine-related presumed allergic reactions and second dose administration by using a two-step graded protocol

Background: Acute allergic reactions to messenger RNA (mRNA) vaccines are rare but may limit public health immunization efforts. Objectives: To characterize suspected allergic reactions to the first dose of coronavirus disease 2019 (COVID-19) mRNA vaccine and to assess the safety and utility of a two-step graded-dose protocol for the second dose of the Pfizer-BioNTech vaccine in patients with a history of low suspicion of anaphylaxis to their first dose. Methods: This was a retrospective evaluation of referrals to the allergy and immunology clinic for a presumed allergic reaction to the first dose of the COVID-19 mRNA vaccine (Pfizer-BioNTech or Moderna) between December 17, 2020, and February 28, 2021. Recommendations for the second dose and outcomes were evaluated by trained board-certified allergists. Results: Seventy-seven patients presented with a Pfizer-BioNTech reaction (56 [72.7%]) or with a Moderna reaction (21 [27.3%]). Most patients (69.7%) had symptom onset within 4 hours. Most commonly reported symptoms were cutaneous (51.9%), cardiovascular (48.1%), and respiratory (33.8%) symptoms. Recommendations included to proceed with the single dose (70.1%), two-step graded dose (19.5%), or deferral (10.4%). Twelve of 15 patients completed the second dose with a graded-dose protocol. Of these patients, five reported at least one or more similar symptoms as experienced with their first dose. Conclusion: Of the patients with presumed allergic reactions to their first dose of COVID-19 mRNA vaccine, most were able to safely receive the second dose. For those with a low suspicion of anaphylaxis, the two-step graded protocol with the Pfizer-BioNTech vaccine was well tolerated. A graded-dose protocol could be an effective strategy for second-dose vaccination in those who may otherwise defer the second dose.

Proactive machine-learning-based approaches to vaccine hesitancy for a potential SARS-Cov-2 vaccine

BackgroundPolls in the US and France found a concerning share of respondents (50% and 26%, respectively) stating that they are not committed to receiving or simply saying they would not accept vaccination against SARS-CoV-2[1][2]. In this context, it is worth revisiting machine-learning approaches to predicting vaccine hesitancy - such as the one developed for MMR vaccination at the individual level by Bell et al.[4] amid Europe's recent measles epidemic - as a first step of a proactive policy.Proposed Methods and ExpectationsIn the MMR case, using 44K child-healthcare records including vaccination data, a LASSO logistic regression based on a low number of attributes of the child and his or her family and community produced risk scores, making them readily interpretable by healthcare professionals. Since children are regularly the target population for immunization efforts, recent pediatric and school-age records, in concert with other social and medical features, could provide suitable input for algorithms estimating the probability of refusal of a SARS-Cov-2 vaccine for other members of a household. This is contingent upon data on acceptance and refusal being collected and paired with these inputs in areas where the vaccine will first be deployed (if developed), which gives another argument for such timely and organized data collection. Speculating about the future performance of a new model trained on truly “out of sample” data specific to a novel problem should be avoided. Benchmarks for success in terms of measures such as precision and recall, however, have to be set in light of the gravity of the issue and other available methods. Finally, any model trained with the aim of predicting vaccine hesitancy for a SARS-Cov-2 vaccine should be coupled with tailored communication policies tested as part of the first vaccination efforts. Cornwall, Science Mag, Jun 30, 2020Peretti-Watel et al., The Lancet, May 20, 2020Bell et al., IEEE ICHI, 2019Key messages Data on acceptance and refusal for the first (potential) SARS-Cov-2 vaccination campaigns should be collected and matched with health records to enable models predicting vaccine hesitancy.The output of machine learning models predicting vaccine hesitancy should be paired with tested policies respectfully communicating reliable information on vaccination.

Community participation in prevention and control of infectious diseases

Historically, the health status of the people of Bangladesh has been greatly influenced by communicable diseases. Infant mortality, maternal mortality, life expectancy and many other health indicators are determined by diseases like cholera, malaria, kala-azar, tetanus and diphtheria. Contamination of water, prevalence of vectors, poor nutritional status and poor hygienic behaviour increase people’s vulnerability to sickness and death when exposed to various communicable diseases. In recent years, however, measures including provision of safe water, better nutritional interventions, vector management, and strengthened immunization efforts brought improvement in health scenario of the country. Health service is a basic requirement for every human being and it is liability of government to ensure adequate medical facilities to the people. People involvement is central to all aspects of human development of which health is one. During the last two decades it becomes obvious that people’s participation is not only beneficial but essential in the pursuit of better health objectives. According to the Alma-Ata conference in 1978, community participation was described as an essential component of primary health care.

Susceptibility to Hepatitis A Virus Infection in the United States, 2007-2016.

Despite national immunization efforts, including universal childhood hepatitis A (HepA) vaccination recommendations in 2006, hepatitis A virus (HAV)-associated outbreaks have increased in the United States. Unvaccinated or previously uninfected persons are susceptible to HAV infection, yet the susceptibility in the US population is not well known. Using National Health and Nutrition Examination Survey 2007-2016 data, we estimated HAV susceptibility prevalence (total HAV antibody negative) among persons aged ≥2 years. Among US-born adults aged ≥20 years, we examined prevalence, predictors, and age-adjusted trends of HAV susceptibility by sociodemographic characteristics. We assessed HAV susceptibility and self-reported nonvaccination to HepA among risk groups and the "immunization cohort" (those born in or after 2004). Among US-born adults aged ≥20 years, HAV susceptibility prevalence was 74.1% (95% confidence interval, 72.9-75.3%) during 2007-2016. Predictors of HAV susceptibility were age group 30-49 years, non-Hispanic white/black, 130% above the poverty level, and no health insurance. Prevalences of HAV susceptibility and nonvaccination to HepA, respectively, were 72.9% and 73.1% among persons who reported injection drug use, 67.5% and 65.2% among men who had sex with men, 55.2% and 75.1% among persons with hepatitis B or hepatitis C, and 22.6% and 25.9% among the immunization cohort. Susceptibility and nonvaccination decreased over time among the immunization cohort but remained stable among risk groups. During 2007-2016, approximately three-fourths of US-born adults remained HAV susceptible. Enhanced vaccination efforts are critically needed, particularly targeting adults at highest risk for HAV infection, to mitigate the current outbreaks.

Partnering with parents to remove barriers and improve influenza immunization rates for young children.

Despite the ongoing public health initiatives to increase pediatric influenza immunization rates to 80%, only a few US health centers have been able to meet this goal. The suboptimal immunity to influenza poses individual and societal risks for vaccine-preventable cases of influenza and its complications. At a diverse, urban, family health center, its influenza immunization rate of 44% represented the lowest uptake rate compared with all other early childhood vaccines, increasing the risk of morbidity and mortality in young children, including hospitalization and death. To identify key barriers to influenza immunization, the investigators interviewed parents of children aged 6 through 24 months at this urban family health center via randomized sampling using an open-ended telephone survey. Based on the concerns parents expressed through the survey, a program was designed and implemented that included reminder calls, parent education, proactive appointment scheduling, and social media reminders. After implementing a parent-driven quality-improvement program for 6 months during influenza season, the health center's pediatric influenza immunization rates rose to 57% compared with 44% during the year before. Childhood immunization is a critical priority to protect the health and wellness of children. Increasing parent engagement in discussions about increasing immunization rates not only promotes awareness surrounding vaccines but also allows primary care providers to learn from parents to create a patient-centered immunization program. Programs that specifically target immunization efforts toward parental concerns have the potential for increased vaccine acceptance and improved health outcomes.

Mandatory Immunization Policy by Rulers from Islamic Perspective

Introduction: Islam views life as a sacred entity that sanctioned utmost protection according to the Objective of Syariah (Maqasid Syariah). Immunization has historically and epidemiologically proven to safeguard human life (hifzun nafs) from life threatening communicable disease. Recent development witnesses increasing vaccine refusal and hesitancy (VHR) which would jeopardize global immunization effort and its desired noble outcome. Hence there is proposal from various party for the Ministry of Health to enact a mandatory immunization policy. This study aims to analyze mandatory immunization policy by governing rulers from Islamic perspective.Methods: This is a qualitative study. Document analysis from Islamic jurisprudence (fiqh) references including some literature on Maqasid Syariah, Qawaid Fiqhiyyah and Siayah Syariah perspective. Interviews with expert from both Islamic scholars and clinicians was conducted.Results: The study recognizes that mass immunization to achieve herd immunity is considered communal obligation (fardhu kifayah). Islamic legal principles such as consideration of public interest (Masalih Mursalah) and blocking evil means (Sadd -az-Zaraie) as well as legal maxim (Qawaid Fiqhiyyah) to prevent harm (darar) would serve as basis to support this policy. The contemporary Islamic jurisprudence approach such as weighting preference (fiqh muwazanat) and considering implications (fiqh ma’alat) may justify the ruler’s action to enact mandatory immunization as in accordance with the principle of Siyasah Syariyyah that the rulers must safeguard the wellbeing of whole community.Conclusion: This study may serve as preliminary paper and reference to respective authorit y and policy makers on Islamic perspective towards mandatory immunization policy.International Journal of Human and Health Sciences Supplementary Issue: 2019 Page: 34

Use of Social Mobilization and Community Mobilizers by Non-governmental Health Organizations in Malawi to Support the Eradication of Polio, Improve Routine Immunization Coverage, and Control Measles and Neonatal Tetanus.

.Seventy-five percent of children aged 12–23 months in Malawi have received all eight basic vaccinations—still leaving many children at risk. The Malawi Expanded Program on Immunization comprehensive Multi-Year Plan 2016–2020 reveals several challenges impeding immunization and disease surveillance efforts, such as the fact that non-governmental health organizations (NGHOs) and communities are minimally included in the planning, implementation, and monitoring of these activities. This article examines the extent to which NGHOs are promoting the use of social mobilization (SM) and community mobilizers (CMs) for sharing health information related to the eradication of polio, the importance of routine immunization, and the control of measles and neonatal tetanus. Data collection involved document analysis and interviews with 11 organizations in Malawi whose work contributes to the eradication of polio and control of measles and neonatal tetanus. Content analysis was used to analyze the qualitative data, whereas descriptive statistics were used to analyze the quantitative data. Non-governmental health organizations use a variety of approaches for SM, including mass media campaigns (radio and printed booklets), local skits and dramas, and home visits. Most NGHOs use training workshops and opinion leaders to impart knowledge and skills to CMs on immunization to eradicate polio and to control measles and neonatal tetanus. Major challenges faced by the NGHOs include negative attitudes toward campaigns and demotivation of CMs due to lack of financial incentives. The article concludes with a discussion of approaches to strengthen SM and the role of CMs by NGHOs.

Accessible metrics of access: Novel tools to measure immunization coverage in rural sub-Saharan Africa

Immunization rates in most sub-Saharan African countries fall far below stated targets. Measuring access in resource-limited settings, however, is challenging, especially with the data available at the district level, which is the primary administrative division for most immunization programs. Despite calls to improve routine data collection and use, there remains a lack of structured methods and practical tools to target underserved populations. Herein, we describe a prospective study that aims to develop, pilot, and validate a set of user-friendly tools to identify geographic areas with limited access to immunization services and by extension, low immunization coverage. The approach will leverage routinely-collected data from public health facilities combined with novel methods of household mapping to perform spatial analyses using open-access platforms. In addition, we will triangulate the analyses across datasets representing common reasons for care seeking – namely, visits for vaccination, antenatal care, and malaria – to improve the accuracy of our estimates. The ultimate goal of this project is to equip front-line providers and district level program managers with novel tools that facilitate timely and accurate analysis of routinely-collected data to guide immunization efforts.

Identification of etiologic agents and clinical characteristics for patients suspected of having pertussis in a large Children's Hospital in China.

In China, pertussis is a major health problem with an increasing incidence despite immunization efforts. Timely and accurate diagnosis is essential for the optimal management of pertussis, especially in severe cases. Nasopharyngeal swabs or sputum specimens were obtained from patients suspected of having pertussis on the day of hospitalization at Shanghai Children's Medical Center from December 01, 2016, to November 30, 2017. The specimens were tested with the FilmArray Respiratory Panel, a multiplex polymerase chain reaction (PCR) assay that detects 16 viruses, Bordetella pertussis (B. pertussis), Mycoplasma pneumoniae (M. pneumoniae), and Chlamydophila pneumoniae (C. pneumoniae). Among the 140 children studied, 50.0% (70/140) were detected with a single pathogen, 45.0% (63/140) were detected with multiple pathogens, and 5.0% (7/140) had no detected pathogens. Forty-nine (35%, 49/140) patients tested positive for B. pertussis. Respiratory syncytial virus (RSV), parainfluenza virus (Para) and rhinovirus/enterovirus (Rhino/Entero) were the most prevalent pathogens in patients with pertussis-like syndrome. No significant differences between the groups with pertussis and pertussis-like syndrome were observed regarding the clinical symptoms. Severe cases were more frequently observed in unvaccinated, premature and pertussis/RSV co-infection patients. Our study highlights the importance of the timely and accurate diagnosis of pertussis based on both clinical symptoms and laboratory methods.

The Use of Syndromic Surveillance Data For Prevention and Monitoring of Hepatitis A

ObjectiveWe describe our efforts to prevent a hepatitis A outbreak in Houston.IntroductionSince 2017, over 11 states have been impacted by outbreaks of hepatitis A among persons experiencing homelessness (PEH) and drug use. The primary methods of transmission for the hepatitis A virus (HAV) are person-to-person contact and ingestion of contaminated foods. The HAV infection typically presents with minor symptoms, but the infection can cause serious complications and death in those with poor health. Houston, TX, the 4th largest U.S. city, has a large, mobile homeless population and is at risk for such an outbreak. Of the US adults surveyed for NHANES, only 27% reported hepatitis A immunity; and the homeless population is considered high risk for acquiring hepatitis A. The Point in Time Homeless Census (2017) estimated 3,412 PEH in the Houston metro area. Nationally, the HAV outbreaks have been marked by high rates of hospitalizations and deaths. Emergency and ambulatory department data was monitored and assessed for HAV-related visits using the Houston Health Department’s (HHD) syndromic surveillance system.MethodsCase reports and syndromic surveillance query were used to assess baseline data. HHD provided single-dose units of Hepatitis A vaccine through the Adult Safety Net program to two community medical providers that deliver care to PEH in Houston. Staff administered vaccines via clinics and outreach efforts. Immunization records were recorded in the state immunization registry. Monitoring of potential outbreaks occurred monthly using the syndromic query. Data from case reports or syndromic surveillance were analyzed once immunization efforts concluded.ResultsFrom 2015-2017, the annual mean of HAV cases reported was 13. Analyses of syndromic surveillance conducted in March and August 2018 revealed no increase in jaundice complaints. Briefings were conducted with multiple stakeholders including community members, medical providers, academia, and health professionals in December 2017. HHD provided 150 single-antigen hepatitis A vaccine allotments to two community partner agencies. Immunizations began in late January 2018; 400 homeless persons had been immunized as of March 30, 2018.ConclusionsOngoing review of surveillance data in conjunction with community assessments of PEH is necessary to prevent a hepatitis A outbreak among PEH in Houston. Since vaccination is cited as the best method of prevention, continuing immunization efforts are needed to build herd immunity.The availability of vaccines was limited due to the increased demand in responding to the multi-state HAV outbreaks. However, Houston Health Department (HHD) had access to doses of the hepatitis A vaccine post Hurricane Harvey. While a mass immunization campaign of at-risk groups would be ideal, staffing isn’t feasible as HHD uses a medical home model for immunization efforts. Innovative public health interventions are required to overcome the inherent challenges of delivering preventive programs to PEH. To prevent a potential HAV outbreak in Houston, comprehensive surveillance strategies should include 1) participatory stakeholder engagement, 2) timely reporting, 3) prompt referrals from providers who care for PEH, 4) community education about transmission and hygiene, and 5) vaccination of at-risk groups to increase herd immunity.

GAMBARAN PENGETAHUAN ORANG TUA TENTANG IMUNISASI MEASLES RUBELLA DI MADRASAH IFTIDAIYAH AL-KAUTSAR PALEMBANG TAHUN 2019

Background:according to the world health organization (WHO) Indonesia’ Immunization program has a goal of reducing Immune-preventable disease and mortality rates. Immunization efforts have been held in Indonesi since 1956. Beginning in 1977, Immunization efforts were expanded into an immunization development program in the prevention of immunization of disease infections (pd3i) such as immunodeficiency, diphtheria, pertusis, measles, tetanus, polio, hepatitis, pneumonia, rotavirus, congenital rubella syndrome, human papillomas. The goal of this studyis to find out what parent’s awareness of the immunization of emergency Bella in the madrassa ibtidayah al-kautsar palembang in 2018. This method of research uses the quantitative descriptive research design, the sample was taken using the 34-parent sampling of madrasah iftidaiyah al-kautsar who is nagaswidak area of labor center. Data analysis using a Univariate analysis, the study was performed in January 2019. The vast majority of 34 respondents were known to have 20 ( 58,8%) when 11(32,4%) had a good knowledge of immunization, while 11(32,4%) had sufficient knowledge and 3(8,8%) had little knowledge. Suggestions: it is hoped that studies could use more varied variables and cover more broader research, so tah research on disease disease and disease could be constantly improved.

Vaccination coverage and factors associated with routine childhood vaccination uptake in rural Vellore, southern India, 2017

BackgroundVellore district in southern India was selected for intensified immunization efforts through India’s Mission Indradhanush campaign based on 74% coverage in the National Family Health Survey in 2015. As rural households rely almost entirely on the Universal Immunization Program (UIP), we assessed routine immunization coverage and factors associated with vaccination status of children in rural Vellore. MethodsWe conducted a cross-sectional household survey among parents or primary caretakers of children aged 12–23 months during August–September 2017 using two-stage, EPI cluster sampling. We verified vaccination histories from vaccination cards and collected data on sociodemographic and non-socio-demographic characteristics by using mobile data capture. Associations with vaccination status were examined with univariate and multivariate logistic regression models. ResultsA total of 643 children were included. Coverage of BCG, third dose pentavalent/DPT, measles/MR vaccines and full vaccination (BCG, three doses of polio and pentavalent/DPT and measles/MR vaccines) among children with vaccination cards (n = 606) was 94%, 96%, 93% and 84%, respectively. Of children with vaccination cards, 70.8% had received all recommended doses according to the UIP schedule. No socio-demographic differences were identified, but parents’ familiarity with the schedule (Adjusted Prevalence Odds Ratio (aPOR): 2.06, 95%CI = 1.26–3.38) and receiving information on recommended vaccinations during antenatal visits (aPOR: 2.16, 95% CI = 1.13–4.12) were significantly associated with full vaccination status of the children. ConclusionsWe found higher UIP antigen coverage and proportion of fully vaccinated children than previously reported from rural Vellore. However, adherence to the recommended schedule was still not optimal. Our study highlights the potential of improving parental awareness of vaccination schedule and targeting health education interventions at pregnant women during antenatal visits to sustain and improve routine immunization coverage.

Mathematical modelling to characterise the in vivo dynamics of Salmonella in the naïve and immunised host

Systemic salmonellosis encompasses typhoid and paratyphoid fever, and invasive non-typhoidal salmonellosis, with high mortality and morbidity amongst children and the immunocompromised in low-resource settings. Immunisation efforts remain hampered by the unavailability of safe vaccines with cross-protectivity against causative Salmonella strains. Characterisation of the within-host Salmonella dynamics in the naïve and immunised host can elucidate the mechanisms by which different vaccine types exert their protective effect, and help in vaccine selection and design. Experimental data tracking the changes in bacterial population composition in the different tissues of the host at different timepoints can be coupled with mechanistic mathematical models to estimate the parameters governing the processes of bacterial replication, killing and inter-organ migration. Using a recently described minimisation-divergence estimation approach, we extend a three-compartmental mechanistic model and re-analyse existing datasets to better characterise the bacterial migratory processes between the blood, liver and spleen in the early stages of infection, and the overall Salmonella dynamics in the later phases in the naïve host. We apply the same model to published data from mice immunised with either a live-attenuated or killed whole-cell vaccine to identify their in vivo differential impacts on Salmonella migration, replication and death. Finally, we identify alternative experimental designs to improve the statistical qualities of the mathematical model and allow better inference of parameters governing the unobserved processes of bacterial dynamics.

Experience implementing a university-based mass immunization program in response to a meningococcal B outbreak

ABSTRACTNeisseria meningitidis serogroup B (MenB) has caused several recent outbreaks of meningococcal disease on US college campuses. In January 2015, a case of MenB was reported at a university in Oregon, culminating in an outbreak with a total of 7 cases (including 1 fatality) identified over a 5-month period. In response to the outbreak, the university organized a mass immunization campaign with 4 “opt-in” immunization clinics. The preparation, challenges, and resources required for organization and implementation of a mass immunization program in response to an outbreak at a large public university are discussed herein. Based on the logistical challenges as well as resource expenditures associated with planning and executing a mass immunization effort, this experience illustrates that proactive, routine immunization of incoming students is the best strategy for MenB outbreak prevention.

Monitoring the age-specificity of measles transmissions during 2009-2016 in Southern China.

BackgroundDespite several immunization efforts, China saw a resurgence of measles in 2012. Monitoring of transmissions of individuals from different age groups could offer information that would be valuable for planning adequate disease control strategies. We compared the age-specific effective reproductive numbers (R) of measles during 2009–2016 in Guangdong, China.MethodsWe estimated the age-specific R values for 7 age groups: 0–8 months, 9–18 months, 19 months to 6 years, 7–15 years, 16–25 years, 26–45 years, and ≥46 years adapting the contact matrix of China. The daily numbers of laboratory and clinically confirmed cases reported to the Center for Disease Control and Prevention of Guangdong were used.ResultsThe peak R values of the entire population were above unity from 2012 to 2016, indicating the persistence of measles in the population. In general, children aged 0–6 years and adults aged 26–45 years had larger values of R when comparing with other age groups after 2012. While the peaks of R values for children aged 0–6 years dropped steadily after 2013, the peaks of R values for adults aged 26–45 years kept at a high range every year.ConclusionsAlthough the provincial supplementary immunization activities (SIAs) conducted in 2009 and 2010 were able to reduce the transmissions from 2009 to 2011, larger values of R for children aged 0–6 years were observed after 2012, indicating that the benefits of the SIAs were short-lived. In addition, the transmissions from adults aged between 26 and 45 years increased over time. Disease control strategies should target children and adult groups that carry high potential for measles transmission.

Reasons for non-vaccination and incomplete vaccinations among children in Pakistan

BackgroundGlobal immunization efforts have received a boost through the introduction of several new vaccines. These efforts however, are threatened by sub-optimal vaccine coverage, particularly in countries with large birth cohorts. Pakistan has one of the largest birth cohorts in the world, where coverage of routine vaccination remains persistently inadequate. We undertook this study to ascertain reasons for non-vaccination or incomplete vaccination of children less than two years in 8 districts of southern Pakistan. MethodsA cross-sectional survey using WHO recommended rapid coverage assessment technique was conducted in 2014. Using probability proportional to size method, we sampled 8400 households with eligible children (aged 4–12 months). Using a structured questionnaire, mothers or other primary caregivers were interviewed to determine vaccination status of an index child. In case of non-vaccination or incomplete vaccination, respondents were asked for reasons leading to low/no vaccine uptake. ResultsBased on both vaccination record and recall, only 30.8% of children were fully vaccinated, 46% had an incomplete vaccination status while 23%were non-vaccinated. The most frequently reported reasons for non-vaccination included: mothers/caregivers being unaware of the need for vaccination (35.3%), a fear of side effects (23%), mother/caregiver being too busy (16.6%), distance from vaccination centers (13.8%), and non-availability of either vaccinators or vaccines at vaccination centers (10.7%). Reasons identified for incomplete vaccination were similar, with caregivers being unaware of the need for subsequent doses (27.3%), non-availability of vaccinators or vaccines (17.7%), mother/caregiver being too busy (14.8%), fear of side effects (11.2%), and postponement for another time (8.7%). ConclusionVarious factors result in non-compliance with vaccination schedules and vaccine refusal within the surveyed communities, ranging from lack of knowledge to non-availability of supplies at vaccination centers. These barriers are best addressed through multi-pronged strategies addressing supply gaps, increasing community awareness and enhancing demand for routine vaccination services.

Lessons Learned from Immunization Providers: Strategies for Successful Immunization Efforts Among Medicare Patients

Despite efforts to increase rates of immunization among Medicare patients, especially racial and ethnic minorities, these rates remain well below Healthy People 2020 targets [1]. It is not difficult […]

Assessing the impact of the Lebanese National Polio Immunization Campaign using a population-based computational model

BackgroundAfter the re-introduction of poliovirus to Syria in 2013, Lebanon was considered at high transmission risk due to its proximity to Syria and the high number of Syrian refugees. However, after a large-scale national immunization initiative, Lebanon was able to prevent a potential outbreak of polio among nationals and refugees. In this work, we used a computational individual-simulation model to assess the risk of poliovirus threat to Lebanon prior and after the immunization campaign and to quantitatively assess the healthcare impact of the campaign and the required standards that need to be maintained nationally to prevent a future outbreak.MethodsAcute poliomyelitis surveillance in Lebanon was along with the design and coverage rate of the recent national polio immunization campaign were reviewed from the records of the Lebanese Ministry of Public Health. Lebanese population demographics including Syrian and Palestinian refugees were reviewed to design individual-based models that predicts the consequences of polio spread to Lebanon and evaluate the outcome of immunization campaigns. The model takes into account geographic, demographic and health-related features.ResultsOur simulations confirmed the high risk of polio outbreaks in Lebanon within 10 days of case introduction prior to the immunization campaign, and showed that the current immunization campaign significantly reduced the speed of the infection in the event poliomyelitis cases enter the country. A minimum of 90% national immunization coverage was found to be required to prevent exponential propagation of potential transmission.ConclusionsBoth surveillance and immunization efforts should be maintained at high standards in Lebanon and other countries in the area to detect and limit any potential outbreak. The use of computational population simulation models can provide a quantitative approach to assess the impact of immunization campaigns and the burden of infectious diseases even in the context of population migration.