Immunization Events Research Articles

Performance Pay Increases Dog Vaccinations to Reduce Human Rabies

ABSTRACT Rural development projects often depend on local community members to coordinate community participation. Using a randomized controlled trial, this paper examines how pay-for-performance for community coordinators affects participation in dog vaccination events to prevent human rabies in Tanzania. Three treatments were implemented: fixed payment only, pay-for-performance only, or a mix of fixed payment and pay-for-performance. Using dog vaccination histories, the experiment equalizes the total expected payment across treatments, isolating the effect of payment type. Mixed payment increases dog vaccinations by 16 percent compared to fixed payment. Each 10 percent increase in per-dog payment raises vaccinations by 0.4 percent. Changing the fixed payment rate has a negligible effect. Thus, pay-for-performance induces higher effort than the fixed component. The findings suggest pay-for-performance can improve the effectiveness of rural development projects such as mass immunization events.

Evidence syntheses to support decision-making related to the Covid-19 pandemic.

The COVID-19 pandemic generated a large volume of scientific productions with different quality levels. The speed with which knowledge was produced and shared worldwide imposed on health management the challenge of seeking ways to identify the best available evidence to support its decisions. In response to this challenge, the Department of Science and Technology of the Brazilian Ministry of Health started offering a service to produce and provide scientific knowledge addressing priority public health issues in the pandemic scenario. Drug treatments, non-pharmacological measures, testing, reinfection and immunological response, immunization, pathophysiology, post-COVID syndrome and adverse events are among the topics covered. In this article, we discuss the strengths and lessons learned, as well as the challenges and perspectives that present a real example of how to offer the best scientific evidence in a timely manner in order to assist the decision-making process during a public health emergency.

AWARENESS AMONG MOTHERS REGARDING CARE OF CHILD DURING PRIMARY IMMUNIZATION - AN INTERVENTIONAL STUDYIN SELECTED HEALTH FACILITY OF HIMACHAL PRADESH

Background: Immunization is an important event in a childs life. Awareness of mothers regarding immunization is an important factor affecting adherence to immunization. Materials and Methods: The study was conducted in Zonal hospital, Solan (HP) to determine effectiveness of an interventional package in terms of awareness of mothers regarding care of children during primary immunizations. Apre-test post-test control group design was used to achieve the objective. Seventy five mothers were enrolled in interventional and control group using systematic random sampling and followed on every immunization event until nine months. Awareness among mothers was assessed at immunization events namely birth, six weeks and nine months using a self-structured tool to assess vaccine related problems among children. Results: Significant increase in the awareness level was seen among mothers in the interventional group and was found associated with their number of children. Conclusion: The interventional package significantly increased awareness among mothers in the intervention group in the initial weeks.

Adverse events following immunization among children during primary immunizations in selected health facility of Himachal Pradesh

Background: Vaccine related problems are commonly reported after immunizations and are a matter of concern for health care professionals. A study on the pattern and rate of incidences of vaccine related problems was conducted among children undergoing primary immunizations. Materials and methods: The study was conducted in Zonal hospital, Solan, Himachal Pradesh. 150 mothers and their children undergoing immunization were enrolled in the study using systematic random sampling and followed on every immunization event until nine months. Vaccine related problems were enquired at every immunization events namely birth, six weeks, ten weeks, fourteen weeks and nine months using a self-structured tool to assess vaccine related problems among children. Results: Pain at vaccination site, redness and swelling, excessive crying, fever, and sleep related problems, feeding problems and fever were common AEFIs reported by mothers among children. Conclusion: AEFIs are frequent and need to be reported. None of the child had any severe reaction or hospitalization after immunization.

Serious adverse event following immunization and thromboembolic events associated with COVID19 vaccination: An analysis of nationwide causality assessment from India

BackgroundVaccines against the COVID-19 pandemic were introduced in late 2020. The present study has been conducted to study the serious Adverse Events Following Immunization (AEFIs) reported for COVID-19 vaccines from India. MethodsSecondary data analysis of the causality assessment reports for the 1112 serious AEFIs published by the Ministry of Health & Family Welfare, Government of India, was conducted. For the current analysis, all the reports published till 29.03.2022 were included. The primary outcome variables analyzed were the consistent causal association and the thromboembolic events. ResultsThe majority of the serious AEFIs assessed were either coincidental (578, 52%) or vaccine product related (218, 19.6%). All the serious AEFIs were reported among the Covishield (992, 89.2%) and COVAXIN (120, 10.8%) vaccines. Among these, 401 (36.1%) were deaths, and 711 (63.9%) were hospitalized and recovered. On adjusted analysis, females, the younger age group and non-fatal AEFIs showed a statistically significant consistent causal association with COVID-19 vaccination. Thromboembolic events were reported among 209 (18.8%) of the analyzed participants, with a significant association with higher age and case fatality rate. ConclusionDeaths reported under serious AEFIs were found to have a relatively lower consistent causal relationship with the COVID-19 vaccines than the recovered hospitalizations in India. No consistent causal association was found between the thromboembolic events and the type of COVID-19 vaccine administered in India.

Real-world safety profile of the 9-valent human papillomavirus vaccine: A study in Zhejiang, China from 2019 to 2021

ABSTRACT The safety profile of the 9-valent human papillomavirus vaccine (9vHPV) was evaluated based on the reporting rate of adverse events following immunization (AEFI) obtained from the passive surveillance data in Zhejiang. The 9vHPV AEFI reports in Zhejiang were collected and reviewed from the National Adverse Event Following Immunization Surveillance System (NAEFISS) from 2019 to 2021. Reporting rates of AEFI were analyzed under multiple aspects, including age, city, number of vaccinations, AEFI categories, and diagnosis categories. This study used the reporting odds ratio (ROR) for anomalous signal assessment. The NAEFISS collected 331 AEFI reports after administering 1,064,851 doses of 9vHPV, with a crude AEFI rate of 3.12/10,000 doses. The third dose had the highest reporting rate of minor vaccine-related reaction (n = 80, 3.06 per 10,000), followed by the first dose (n = 134, 2.98 per 10,000), and second dose (n = 76, 2.15 per 10,000). Fever/redness/induration was the most common minor adverse event (281 records, 2.64/10,000 doses). Nine cases of urticaria, ten cases of allergic rash, and ten cases of syncope were recorded. This study found a positive signal association between 9vHPV immunization and adverse events such as syncope, encephalitis, sterile abscess, and urticaria. This study did not identify any new emerging safety concerns. In the future, more research is needed to validate and further explore adverse reactions associated with 9vHPV.

Covid-19 Vaccine Acceptance, Intention to Participate and its Associated Adverse Events Happening among the Vaccinated Population of Lahore, Pakistan

Background: This cross-sectional study being instrumented by a close ended questionnaire was conducted to evaluate society’s affirmation for being jabbed with COVID-19 vaccine, their acquisition towards immunization and associated anomalies in vaccinated people. According to the recent update from WHO, the glob is facing 5th wave of pandemic “Omicron”. However, the problem is that vaccines were in trials. Majority of people were demonstrating reluctance for being immunization against COVID-19 due prevailing oddities after vaccination. Aim: To measure the possible adverse effects caused by the vaccination and society’s participation towards immunization. Methodology: In this study we adapted cross sectional study design by means of convenience sampling. Study instrument was a close ended questionnaire. Data was collected from only vaccinated participants by visiting universities, medical personnel, colleges and other society sectors under the supervision of team members. Data transferred to software SPSS to extract the results. Cross tabulation was used for demographic analysis such as age, gender and vaccine type jabbed. Results: The most common adverse effects include inflammation at site of injection, fever, nausea and vomiting, diarrhea, abdominal pain, joint pain and numbness of limbs were highlighted. Mostly jabbed vaccine types include Sinopharm and Sinovac. Majority of respondents showed willingness for immunization however, only a small proportion was afraid for being vaccinated. The significance in our study that we have conducted study for acceptance of vaccine, intention of participants towards immunization and adverse events associated with different types of COVID-19 vaccines in vaccinated population residing in different towns of Lahore, Pakistan. Conclusions: In our local population, majority accepted the vaccine and didn’t deny to administer the vaccine. Pain, redness, lethargy, nausea, vomiting, diarrhea, abdominal pain, numbness and arthritis were noted to be the most common side effects of COVID- 19 vaccine. Keywords: COVID-19, Vaccine Acceptance, Pakistan, Vaccinated Population

COVID-19 in children: epidemic issues and candidate vaccines.

A large-scale vaccination of coronavirus disease-19 (COVID-19) in adults has been conducted for nearly a year, and there is a growing recognition that immunization for children is also essential. It has been months since emergency use of pediatric COVID-19 vaccine was approved, we reviewed the prevalence and transmission of COVID-19 in children. The prevalence of COVID-19 in children is reduced due to vaccination even in a Delta prevalent period, so an increase in the vaccination rate is needed in children. Although the precise role of children in the transmission requires more research to uncover, they likely played a significant role, according to the available literature. We also described four candidate COVID-19 vaccines for children on their safety and immunogenicity and the impact of severe acute respiratory syndrome coronavirus 2 variants on childhood vaccination. Safety issues on pediatric vaccines post-approval, like adverse events following immunization and adverse events of special interest require studies on long-term and effective regulatory mechanisms.

COVID-19 Vaccine Distribution: Bolstering the Air Force Immunizations Model.

From its emergence and declaration as a worldwide pandemic, coronavirus disease-2019 (COVID-19) has been associated with significant medical and logistical challenges. Initial obstacles ranged from the need to develop testing platforms to the determination of effective treatments to decrease the significant morbidity and mortality associated with the disease. Due to significant scientific breakthroughs, the most recent pressing challenge has been the distribution of vaccines against severe acute respiratory syndrome coronavirus 2 to prevent the spread of the infection across the world. Historically, the U.S. Military has been involved in immunizations delivery to prevent disease among its troops. This experience has led to the establishment of programs designed to distribute safe vaccinations to service members and beneficiaries. It is upon this infrastructure that the Air Force (AF) medical community was thrust to devise and execute COVID-19 vaccine delivery implementation across all military treatment facilities. In the AF, specialty trained allergist and immunologists provide the technical expertise for the establishment and execution of the AF immunizations program. These medical professionals have the proficiency, knowledge, and experience to run efficient mass immunization events in order to provide vaccines in a safe and rapid environment. Despite this, significant challenges attributable to the variable and novel nature of COVID-19 vaccine logistical requirements have led to unanswered questions and debate that needed resolution before and during the launch of this program. Here we describe the process for establishing a mass vaccination program for COVID-19 vaccine delivery and our experience-based problem solving approach at a large AF military treatment facility.

Using a low-cost, real-time electronic immunization registry in Pakistan to demonstrate utility of data for immunization programs and evidence-based decision making to achieve SDG-3: Insights from analysis of Big Data on vaccines

BackgroundDespite the proliferation of digital interventions such as Electronic Immunization Registries (EIR), currently, there is little evidence regarding the use of EIR data to improve immunization outcomes in resource-constrained settings. To achieve the Sustainable Development Goal (SDG) of ensuring healthy lives and well-being for all ages, particularly for newborns and children under the age of 5 (goal 3b), it is essential to generate and use quality data for evidence-based decision making to overcome barriers inherent in immunization systems. In Pakistan, only 66 % of children receive all basic vaccinations, and in Sindh province, the number is even lower at 49 %. In 2012, IRD developed and piloted Zindagi Mehfooz (Safe Life; ZM) ElR, an Android-based platform that records and analyses individual-level child data in real-time. In 2017 in collaboration with Expanded Programme for Immunization (EPI) Sindh, ZM was scaled-up across the entire Sindh province and is currently being used by 2521 government vaccinators in 1539 basic health facilities, serving >48 million population. ObjectiveThe study aims to demonstrate how big immunization data from the ZM-EIR is being leveraged in Sindh, Pakistan for actionable decision making via three use cases (a) improving performance management of vaccinators to increase geographical coverage, (b) quantifying the impact of provincial accelerated outreach activities, and (c) examining the impact of the COVID-19 pandemic on routine immunization coverage to help devise a tailored approach for future efforts. MethodsFrom October 2017 to April 2020, more than 2.9 million children and 0.9 million women have been enrolled, and more than 22 million immunization events have been recorded in the ZM-EIR. We extracted de-identified data from ZM-EIR for January 1, 2019 – April 20, 2020, period. Given the needs of each use case, monthly and daily indicators on vaccinator performance (attendance and compliance), daily immunization visits, and the number of antigens administered were calculated. Geo-coordinate data of antigen administration was extracted and displayed on geographic maps using QGIS. All generated reports were shared at fixed frequency with various stakeholders, such as partners at EPI-Sindh, for utilization in decision making and informing policy. ResultOur use-cases demonstrate the use of EIR data for data-driven decision making. From January – December 2019, the monthly monitoring of program indicators helped increase the vaccinator attendance from 44% to 88%, while an 85 % increase in geographical coverage was observed in a polio-endemic super high-risk union council (SHRUC) in Karachi. The analysis of daily average antigens administered during accelerated outreach efforts (AOE) as compared to routine activities showed an increase in average daily Pentavalent-3, Measles-1, and Measles-2 vaccines administered by 103%, 154%, and 180% respectively. These findings helped decide to continue the accelerated effort in high-risk areas (compared to the entire province) rather than discontinuing the activity due to high costs. During COVID-19 lockdown, the daily average number of child immunizations reduced from 16,649 to 4335 per day, a decline of 74% compared to 6 months preceding COVID-19 lockdown. ZM-EIR data is currently helping to shape the planning and implementation of critical strategies to mitigate the impact of the COVID-19 pandemic. ConclusionThe big data for vaccines generated through EIRs is a powerful tool to monitor immunization work-force and ensure chronically missed communities are identified and covered through targeted strategies. Geospatial data availability and analysis is changing the way EPI review meetings occur with stakeholders, taking data-driven decisions for better planning and resource allocation. In the fight against COVID-19 pandemic, as governments gradually begin to shift from containing the outbreak to strategizing a plan for sustaining the essential health services, the countries that will emerge most successful are likely the ones who can best use technology and real-time data for targeted efforts.

Immunization practices and adverse events following vaccination in infants admitted to the Neonatal Intensive Care Unit

Objective: To determine if vaccinations administered in the neonatal intensive care unit (NICU) were administered following Centers for Disease Control and Prevention guidelines while assessing for adverse reactions in the 48 hours post-vaccination. Study Design: Retrospective cohort study of infants who received Diphtheria-Tetanus-Pertussis, inactivated Polio, Hepatitis B vaccines during NICU admission from February 2016 to January 2017 with a total of 337 immunization events reviewed. Data were assessed to determine vaccination delay according to recommended schedules as well as rate of adverse events. Knowledge base and attitudes were evaluated through a questionnaire administered over a three-week period to NICU care providers. Results: Of the 337 immunization events reviewed, 256 vaccines were administered within 7 days of the recommended vaccination schedule, leaving 24% (n=81) administered outside of this schedule. Taking into account weaning of respiratory support and deterioration of respiratory status in the 48 hours prior to vaccination, total adverse event rates for the remaining 312 immunization events were 2% (n=7). Questionnaire showed many providers felt adverse events are commonplace following vaccination and highlighted a possible gap in knowledge of recommended vaccination guidelines. Conclusions: This study suggests neonates admitted to the NICU are at risk for vaccination delay. Immunizations have a low rate of adverse events, thus confirming safety. Factors that may increase adverse events post-immunization include coincidental worsening of overall status and recent wean in respiratory support. Further studies are needed to examine best practices to promote improved vaccination in the NICU.

Supervision and monitoring to assess quality of outreach immunization sessions in a rural area using a checklist

Background: Immunization is one of the most cost-effective interventions to prevent the suffering that comes from avoidable sickness, disability and death. Outreach immunization services ensure that immunization is available to children who are unable to access a general practice in a timely fashion for their immunization events. Effective supervision and monitoring will help in improving quality and coverage of immunization.Methods: This was an observational cross-sectional study conducted in the rural field practice area of a tertiary care hospital. 50 outreach sessions held in various outdoor places including Anganwadi were supervised and monitored using checklist. 110 mothers and 20 stakeholders were interviewed. Immunization records were assessed.Results: Outreach immunization sessions were found to be of good quality. 89% children were fully immunized. ANMs and ASHAs were of the opinion that outreach session has significantly raised immunization coverage. 75.4% mothers had knowledge about services provided by outreach sessions.Conclusions: There was increase in immunization coverage due to outreach sessions. There is need for adequate supervision on safety injection practices and regular timely incentive to ASHA.

A Demand for Data to Improve Outcomes Creates the Why to Move to Third Generation Immunization Information Systems.

Investments over the past two decades to collect and store immunization events established a national population health data asset. The ability to track vaccine usage and storage has increased accountability, lowered wastage, protected valuable resources, and provided the correct vaccines at the right time. Sixty-four immunization registries support the current immunization ecosystem, yet all investments to date have been through state and federal funding. Much of the technology supporting these registries is becoming harder to support, limiting the utilization of the data. For the most part all current systems have legacy 2nd-generation technology and architectures as their foundation Current technology investments in these national assets tend to be for systems that within the next five years will not be cost effectively sustainable with only federal, state and local funding. Yet quality data is being reported by immunization providers across the health care network that is increasing exponentially through electronic data exchanges integrated within Electronic Health Records (EHR) and Pharmacy Management Systems (PMS) This increase in high-quality patient immunization records creates opportunity to build immunization intelligence from the data. However, 2nd-generation Immunization Information Systems (IIS) limit the effective and timely use of this information. Considering the increasing value of the data to public and private sectors working to close immunization care gaps in populations, supporting technology must ensure easy access This is the first of two papers that highlights the power of these national registries and the data they contain to provide opportunity intelligence to the immunization ecosystem user community. Paper one illustrates the "why" for change and the need for a truly community collaborative path forward to move from 2nd- to 3rd-generation systems through partners that leverages cost sharing and common goals The end goal is to establish new supporting technology assets that accelerate the use of data to impact vaccine preventable disease (VPD) outcomes which create a new model for public-private investments to sustain the IIS national infrastructure. The second a working paper with assumptions to be tested ("Model for Sustaining and Investing in Immunization Information Systems"), shares cost and investment strategies to complete the migration and create sustainable immunization systems for the future.

A Model for Sustaining and Investing in Immunization Information Systems: Authors.

In the past three years, Scientific Technologies Corporation electronically sent one-hundred fifty million retail pharmacy patient immunization events to state and community public health immunization information systems. Today, as a conservative estimate, over 85% of the U.S. population has an immunization record in an electronic health information system. Health technology, data exchange and increasing online patient health records offer consumers, providers and the immunization community new platforms to proactively identify vaccine coverage gaps. As the value of online immunization information increases, the cost to sustain and leverage these new technologies escalates. Online immunization records and integrated decision support tools are being used extensively from the pharmacy to the emergency room. They are moving from health data vaults with few users to more ubiquitous point of care services and direct consumer engagement. The data and the supporting technology infrastructure empower the community within the immunization ecosystem. To use this opportunity to reduce the impact of vaccine preventable disease on populations, investment in sustaining and modernizing existing immunization health technology systems suggest models to articulate their value and return on investment. This paper illustrates cost and technology drivers that impact sustainability and modernization of the immunization information system infrastructure. It provides a model to support investment priority decisions and estimate costs. It reviews the technical evolution of public health immunization registries and their current legacy state providing a pathway to migrate to opportunistic third generation technology platforms. It will answer: How much should be budgeted? What can this budget achieve over the next five years? What investments should be prioritized? Is there opportunity for public-private partnerships to support sustainment cost sharing? It shows that an investment of fifty million will modernize a quarter of the current second generation immunization systems and support the remainder over the next five years.

Natural Clostridioides difficile Toxin Immunization in Colonized Infants.

Clostridioides (Clostridium) difficile colonization is common among infants. Serological sequelae of infant C. difficile colonization are poorly understood. In this prospective cohort study of healthy infants, stools serially collected between ages 1-2 and 9-12 months were tested for non-toxigenic and toxigenic C. difficile (TCD). Cultured isolates underwent whole-genome sequencing. Serum collected at 9-12 months underwent measurement of IgA, IgG, and IgM against TCD toxins A and B and neutralizing antibody (NAb) titers against toxin B. For comparison, antitoxin IgG and NAb were measured in cord blood from 50 mothers unrelated to study infants. Among 32 infants, 16 (50%) were colonized with TCD; 12 were first colonized >1 month before serology measurements. A variety of sequence types were identified, and there was evidence of putative in-home (enrolled siblings) and outpatient clinic transmission. Infants first colonized with TCD >1 month prior had significantly greater serum antitoxin IgA and IgG against toxins A (P = .02 for both) and B (P = .009 and .008, respectively) compared with non-TCD-colonized infants, and greater IgG compared with unrelated cord blood (P = .005). Five of 12 (42%) colonized infants had detectable NAb titers compared with zero non-TCD-colonized infants (P = .02). Breastfeeding was not associated with differences in serological measurements. TCD colonization is associated with a humoral immune response against toxins A and B, with evidence of toxin B neutralization in vitro. The extent and duration of protection against CDI later in life afforded by natural C. difficile immunization events require further investigation.

The Power of Consumer Activism and the Value of Public Health Immunization Registries in a Pandemic: Preparedness for Emerging Diseases and Today's Outbreaks.

Public Health immunization registries and the immunization ecosystem have evolved over the past two decades to become significant population health data assets. Clinical providers and pharmacists are reporting the immunizations given to their patients to public health registries in 49 states and all territories, creating consolidated immunization event patient records.Most of these immunization events are reported through the provider’s Electronic Health Record system (EHR), Pharmacy Management System (PMS), online, or through data uploads. Meaningful Use and health data standards (HL7) became the drivers that accelerated reporting to immunization registries and significantly improved the quantity and quality of the data. The infrastructure supporting the Immunization Ecosystem (IE) has enabled real-time compliance reporting and, more importantly, real-time patient queries. The provider community now has online access to a patient’s immunization history in over three quarters of the states, and growing. This access includes a forecast of the patient’s immunization gaps provided by public health decision support tools based upon the most recent ACIP recommendations. This is creating an opportunity for the provider and the patient to work together to reduce their risk of suffering a vaccine-preventable disease. This IE and the data in an Immunization Information System (IIS) are especially useful as pharmacies expand their immunization practices and create opportunities to reduce the adolescent and adult immunization gaps.In a few states, this provider-public health ecosystem has begun to extend to individuals by allowing them to access the IIS online through the use of MyIR. MyIR provides them with the electronic version of their immunization "yellow cards," recommendations for immunizations due, and the ability to print official certificates. This emerging consumer engagement creates opportunities to empower individuals to be more proactive in their family’s health care.This paper builds upon early experiments to empower individuals in this ecosystem by leveraging the value of these public health data assets and trusted communications, illustrating the possibilities for engaging consumers to support reducing the impact of emerging diseases, outbreaks and the next pandemic. This paper will suggest the value of the IE and the role individuals can play within their own social networks to advance public health efforts to manage disease events. In turn, this social mission would encourage consumers to be more proactive in managing their own healthcare.

Profile Interview With Norman E. Fenn

Shannon L. Castek is a fourth-generation Boilermaker and fourth-professional-year student in the Purdue University College of Pharmacy. Throughout her time in pharmacy school, Shannon has enjoyed supplementing her curricular work with service-learning activities, participating in health screenings and immunization events with the Purdue chapter of the American Pharmacists Association–Academy of Student Pharmacists. She plans to pursue a pharmacy residency following graduation to achieve her dream of becoming an ambulatory care pharmacist. In this article, Shannon highlights the service-learning endeavors of Dr. Norman Fenn in the College of Pharmacy.

Managing public health data: mobile applications and mass vaccination campaigns.

In response to data collection challenges during mass immunization events, Denver Public Health developed a mobile application to support efficient public health immunization and prophylaxis activities. The Handheld Automated Notification for Drugs and Immunizations (HANDI) system has been used since 2012 to capture influenza vaccination data during Denver Health's annual employee influenza campaign. HANDI has supported timely and efficient administration and reporting of influenza vaccinations through standardized data capture and database entry. HANDI's mobility allows employee work locations and schedules to be accommodated without the need for a paper-based data collection system and subsequent manual data entry after vaccination. HANDI offers a readily extensible model for mobile data collection to streamline vaccination documentation and reporting, while improving data quality and completeness.

Anti-D Antibodies in Pregnant D Variant Antigen Carriers Initially Typed as RhD+

Background: To evaluate the incidence, the consequences, and the prevention strategy of anti-D alloimmunizations of D variant carriers in the obstetric population of Split-Dalmatia County, Croatia. Methods: RhD immunization events were evaluated retrospectively for the period between 1993 and 2012. Women were tested for RhD antigen and irregular antibodies. Those with anti-D antibody who were not serologically D- were genotyped for RHD. They were evaluated for their obstetric and transfusion history and their titer of anti-D. The neonates were evaluated for RhD status, direct antiglobulin test (DAT), hemoglobin and bilirubin levels, transfusion therapy as well as phototherapy and outcome. Results: Out of 104,884 live births 102,982 women were tested for RhD antigen. Anti-D immunization occurred in 184 women which accounts for 0.9% of individuals at risk of anti-D formation. 181 cases occurred in women serologically typed as D-. Three women were partial D carriers (DVa n = 2, DNB n = 1), initially typed RhD+, and recognized as D variant carriers after the immunization occurred. Anti-D titer varied from 1:1 to 1:16. Six children were RhD+, four had positive DAT, and two underwent phototherapy. Conclusion: Anti-D immunization occurred in pregnant partial D carriers (DVa, DNB). RhD+ children had serologic markers of hemolytic disease of the fetus and newborn (HDFN), with no cases of severe HDFN.

The NITAG Resource Centre (NRC): One-stop shop towards a collaborative platform

It has long been acknowledged that there is little interaction between National Immunization Technical Advisory Groups (NITAGs) in the North and even less between those in the North and those in the South. Three international meetings of NITAGs recommended establishing an international network of NITAGs centred on a core functional structure and platform to facilitate future exchanges.The SIVAC Initiative (as part of a WHO Collaborating Center) followed-up with this recommendation, and launched an interactive platform involving all NITAGs worldwide in an active network and open collaboration: the NITAG Resource Center (NRC), accessible at http://www.nitag-resource.org.The NRC offers NITAG members and secretariats a centralized access to NITAG recommendations from around the world, systematic reviews, scientific publications, technical reports, updates from partners, and upcoming immunization events. A dedicated network manager will proactively update all contents through a strong network of regional and national focal points.The NRC is a first step towards a more fruitful and global collaboration between NITAGs.