Immunization In India Research Articles

P-2064. COVID-19 Vaccination-infection Status and Immunological Profile: Identification of High-Risk Population for Targeted Booster Immunization In India

Abstract Background The immunological profiles and predictors of immune response in people with hybrid immunity, resulting from a combination of natural infection and vaccination, particularly in regions where non-mRNA vaccines were administered, remain less understood. Methods This was a cross-sectional study done at AIG Hospitals, Hyderabad, India. Consecutive participants were enrolled, and sampled for immunological testing. The study population was divided into six cohorts based on their infection and vaccination status. Immunological assays were performed to measure anti-spike protein and interferon-γ release assay. Hospitalization rates were compared in all groups. Chi-square test was used to compare categorical variables, and the Mann-Whitney U test was used for comparing medians. Post-hoc Dunn test was used for pairwise comparison. Bonferroni adjustment for p-value was performed for multiple pairwise comparisons. Linear regression model was used appropriately to find predictors of antibody titres. Results A total of 1040 patients were enrolled in the study. The population was divided into six cohorts: Unvaccinated, Primary, Booster, Hybrid (Pre-Omicron only), Hybrid (Omicron only), and Hybrid (Both). Antibody titres and IGRA levels were found to be statistically higher in the Hybrid (both infection) group (Table 1 and Figures 1a & 1b). The linear regression model showed factors predicting antibody response (Table 2). Age and hypertension were independent (negative) predictors of antibody levels. During the follow-up (median 30.7 [26.6 – 34.4 months]) of 1008 patients, 770 (76.4%) had a documented COVID infection with Omicron. Hospitalization was evaluated in three groups: Hybrid, vaccination only and unvaccinated. The incidence was significantly lower in the Hybrid group; log-rank test: p < 0.001. (Figure 2) Conclusion The prevalence of hybrid immunity was high in the study population. Individuals above 60 years old and with comorbidities are more likely to have lower antibody titers. Immunized patients were protected against hospitalization. There is a need for prioritized immune-boosting efforts in high-risk individuals. Disclosures All Authors: No reported disclosures

IAPSM’s Position Paper on the Human Papilloma Virus (HPV) Vaccine for Adult Immunization in India

Cervical cancer ranks as the second most common cancer in women in India, primarily caused by persistent infection with the human papillomavirus (HPV). Given its long latent period, secondary prevention through screening and early detection is essential. However, fear and stigma associated with cancers and the costs involved in disease management are the prominent barriers to its uptake. HPV vaccination is one of the vital components of the World Health Organization’s (WHO) Global Strategy to speed up the elimination of cervical cancer as a public health problem. In India, four prophylactic HPV vaccines are currently available. These vaccines are non-infective and highly immunogenic, safe, and effective when administered before HPV exposure. According to WHO recommendations, the primary target group for HPV vaccination consists of girls between the ages of 9 and 14 years. Further, studies have confirmed that both single-dose and two-dose schedules of the HPV vaccine offer comparable efficacy and protection. HPV vaccines are administered intramuscularly in the deltoid region, with 0.5 ml as the standard dose. These vaccines may cause local reactions, as well as mild systemic reactions, such as headache and myalgia, but they are transient. Implementing catch-up vaccination for adolescent girls aged between 9 and 14 years at the time of HPV vaccine introduction would be a cost-effective and sustainable strategy. This would serve as a crucial component of public health efforts to manage HPV infections and eliminate cervical cancer in India.

IAPSM’s Position Paper on Influenza Vaccines for Adult Immunization in India

Influenza causes significant morbidity, hospitalizations, and mortality due to lower respiratory tract infections in India. This paper reviews the current evidence regarding influenza epidemiology, the need for vaccination, immunogenicity, and efficacy of available vaccines and provides recommendations for influenza vaccination for adults by the Indian Association of Preventive and Social Medicine (IAPSM). The risk group among adults includes people with chronic disease, the elderly, immunocompromised individuals, pregnant women, travelers, and healthcare workers. Influenza activity is affected by seasons, humidity, and latitude, leading to variability in influenza peaks in different regions of India. The most effective preventive intervention against influenza is vaccination. Current influenza vaccines have good safety profiles, vaccine efficacy, and acceptable cost-effectiveness. As the virus mutates, the vaccine composition should follow WHO recommendations for the current influenza season. Introducing readily available, conventional, and less expensive trivalent influenza vaccines under the national program can achieve maximum impact on the adult population and potentially prevent future outbreaks and pandemics. IAPSM recommends considering routine use of IIV for all individuals above 60 years, adults with comorbidities, and pregnant women in India. The program managers should consider the pattern of influenza seasonality in a particular region. Influenza surveillance conducted through a structured network of laboratories in India has the potential to provide information about circulating strains, morbidity, and mortality. IAPSM emphasizes conducting community-based studies regarding influenza’s burden, vaccine efficacy, timing of vaccination, and cost-effectiveness among Indian adults to generate evidence.

Developments and Trends of Immunization in India: A Narrative Review.

Immunization is a critical component of public health, and it undergoes various trends and developments over time. Immunization is considered one of humanity's most remarkable journeys. It has helped save countless lives and will help save more if the goals of the 2030 Immunization Agenda (IA2030)are achieved. India is home to one of the largest global immunization programs. Immunization trends refer to the patterns and changes in the development of vaccines, the use of vaccines, and vaccination programs within a nation. There have been various trends in vaccine development and immunization in India. Trends can be influenced by various factors, including vaccine coverage, new vaccines, vaccine hesitancy, advances in medical science, technological innovations, public-private partnerships, public health policies, and public awareness. India has the world's largest immunization program regarding the number of vaccinations delivered, the recipients, the geographic spread, and the human resources required. In this review, we give an overview of various trends in immunization in India dating from the ancient era. A search of the PubMed, Scopus, and Google Scholar databases from 1945 to February 2024was done to conduct a narrative review. This review includes English-language publications. This narrative review was conducted to summarize the government of India's actions and strategies for immunization and vaccine development and also to trace the trends in immunization in India. It covers various vaccination programs of the Indian government and measures that were made to fight vaccine hesitancy and to enhance vaccination coverage such as developing vaccination roadmaps, scheduling vaccinations, utilizing digital health technology, monitoring vaccinations, and developing creative techniques.India has the world's largest Universal Immunization Program,vaccinatingaround 29 million pregnant women and 26.5 million infants annually.These trends reflect India's ongoing commitment to immunization as a component of public health policy and efforts to address existing and emerging health challenges.

Need and Rationale of the Adult Immunisation in India: A Review

Abstract A comprehensive literature review of published articles (till October 2023) was done through PubMed, Embase and Google Scholar search engines to delineate the need for adult immunisation, recommended adult vaccines, barriers to adult immunisation, future research areas and way forward in the Indian context. A total of 29,894 articles were screened from PubMed, Embase and Google Scholar. Of these, a full-text review of 53 articles was done. The findings emphasised the need for adult immunisation in India because of the growing vulnerable elderly population with comorbidities, immunosenescence, waning immunity, rising incidence of VPDs leading to higher morbidity and mortality amongst them, rising cost of hospitalisation and the emergence of antimicrobial resistance. The recommended adult vaccines include human papilloma virus vaccine, pneumococcal vaccine, influenza and typhoid vaccine for healthy adults and special population groups, respectively. Challenges include less prioritisation in the National Vaccination Policy, insufficient awareness amongst healthcare providers and vaccine hesitancy.

Analysis of Age Appropriate Measles Immunisation among the Eligible Children in India: A Cross-Sectional Analysis of National Family Health Survey–5

Abstract Background: Measles continues to pose a significant health threat to children in India, contributing significantly to the global burden of measles-related fatalities. Moreover, a considerable number of children did not even receive their first dose of the measles vaccine, and those who did generally did not receive it at the recommended age. Additionally, there is limited information available in India about age-appropriate measles immunization coverage. Hence, a modest attempt was made to evaluate the extent of timeliness of measles immunization and identify factors associated with the administration of the same among children aged 12 to 23 months in India. Materials and Methods: Data from the most recent National Family Health Survey (NFHS 5, 2019–2021) were used in the present study. The sample comprised 48,928 children aged 12 to 23 months. Cox Proportional Hazard regression analysis was used to determine the significant influencing factors on age-appropriate measles immunization in India. Results: Despite fairly up-to-date measles immunization coverage in India, more than 55% of immunized children received their immunization after the recommended age. Significant percentages of untimely immunization were observed for a substantial number of States and Union Territories across India. From the regression analysis, maternal age and education, religious affiliation, access to media, and healthcare-seeking behaviors such as institutional delivery and utilization of antenatal checkup were identified as the prominent factors related to age-appropriate immunization in India. Conclusion: Untimely immunization is a crucial issue in India. Addressing the timeliness of measles immunization requires a comprehensive strategy that includes healthcare delivery, family planning, immunization perception, and general education. Efforts should be prioritized to improve awareness and accessibility for ensuring timely immunization, thereby safeguarding the health of children across India.

IJCM_273A: Severe adverse events following Covid 19 vaccination immunisation in India: Retrospective Study.

Background: Coronavirus disease 2019 is a newly emerged viral infection reported in India on 30th Jan 2020. Because of high transmissibility rate it spread rapidly and become a pandemic in the year 2020. Though it was a new disease, there were no specific treatment measures for the same. COVISHIELD is the vaccine manufactured from serum institute of India and give approval for emergency use from 30th Dec 2020 without conducting phase trials, Because of numerous infective cases, complications and deaths. There is no separate AEFI surveillance system for COVID 19 vaccines. All the AEFIs were reported via immunization division of Ministry of Health and Family welfare. Objective: 1. To identify the type of AEFI following COVID 19 vaccination. 2. To detail the outcome of AEFI following COVID 19 vaccination Methodology: An observational study on AEFI following COVID 19 vaccination in India, the secondary data during 2020 to 2022 was collected from the open access government data http://surl.li/npkmb from 1st to 20th Oct 2023. The causality assessment results, 254 reported serious AEFI cases were approved by National AEFI Committee on 3rd May 2022.2 The data analysed by using SPSS Statistics. Results: A total of 125 million COVID 19 vaccine doses were administered all over India till 2nd Feb 2022. Out of which 254 reported serious AEFI. Among this 20.1% were =60 years of age. Serious AEFI with hospitalization was 57.9% and death was 42.1%. Around 30.7% cases were found to have a consistent causal association to vaccination. Among this 60.26 %were anxiety related and 39.74 % were vaccine product related. 8 deaths per 1 lakh COVID 19 vaccinations. Only 24.4% of the people with severe AEFI have comorbidities. Conclusion: Benefits of COVID 19 vaccination are enormous. However, as a measure of utmost precaution, all emerging AEFI are being constantly tracked and reviewed periodically.

Immunization in India: A systematic review of the programme

Immunization in India: A systematic review of the programme

The Current State of Adult Immunization in India: Challenges and Opportunities

Abstract Immunization has been a quintessential part of preventive health saving millions of lives from Vaccine preventable diseases. Adult immunization has also been accepted as an important intervention mandated by immunosenescence and newer co-morbidities faced by adults. However, there has been little headway in establishing adult immunization as an integral aspect of health care for older adults in India. There have been several challenges identified for this scenario. Apart from limited guidelines for vaccinating adults, poor awareness, limited access, vaccine hesitancy and expense play an important role. Though customized guidelines for the Indian population is warranted along with improving awareness about vaccines in the adult population, access to care through adult vaccines are mandatory to establish a functional system. Apart for reiterating vaccines that are most useful for the Indian adults, this commentary outlines the various facets of setting up an adult vaccine clinic in the Indian context.

Variable neutralizing antibody responses to 10 SARS-CoV-2 variants in natural infection with wild- type (B.1) virus, Kappa (B.1.617.1), and Delta (B.1.617.2) variants and COVISHIELD vaccine immunization in India: utility of the MSD platform.

For the efficacy of COVID-19 vaccines, emergence of variants accumulating immune-escape mutations remains a major concern. We analyzed the anti-variant (n = 10) neutralization activity of sera from COVID-19 patients infected with Wuhan (B.1), Kappa, and Delta variants and COVISHIELD vaccine recipients with (prepositives) or without (prenegatives) prior antibody positivity using V- PLEX ACE2 Neutralization Kit from MSD. MSD and PRNT50 correlated well (r = 0.76-0.83, p < 0.0001). Despite the least antibody positivity in Kappa patients, anti-variant neutralizing antibody (Nab) levels in the responders were comparable with Delta patients. Vaccinees sampled at 1 month (PD2-1) and 6 months (PD2-6) post-second dose showed the highest seropositivity and Nab levels against the Wuhan strain. At PD2-1, the responder rate was variant-dependent and 100% respectively in prenegatives and prepositives. Nab levels against B.1.135.1, B.1.620, B.1.1.7+E484K (both groups), AY.2 (prenegatives), and B.1.618 (prepositives) were lower than that of Wuhan. At PD2-6, positivity decreased to 15.6%-68.8% in the prenegatives; 3.5%-10.7% of prepositives turned negative for the same four variants. As against the decline in Nab levels in 9/10 variants (prenegatives), a further reduction was seen against the same four variants in the prepositives. These variants possess immune-evasion-associated mutations in the RBD/S region. In conclusion, our data show that the Nab response of patients to multiple variants depends on the infecting variant. We confirm superiority of hybrid immunity in neutralizing multiple variants. Depending on the infecting variant pre- or postvaccination, immune response to different vaccines in different populations will vary and impact protection against emerging variants. The MSD platform provides an excellent alternative to live virus/pseudovirus neutralization tests.

Immunogenicity and safety of homologous and heterologous booster vaccination of ChAdOx1 nCoV-19 (COVISHIELD™) and BBV152 (COVAXIN®): a non-inferiority phase 4, participant and observer-blinded, randomised study.

Primary SARS-CoV-2 vaccination has been shown to wane with time and provide lower protection from disease with new viral variants, prompting the WHO to recommend the administration of booster doses. We determined the safety and immunogenicity of homologous or heterologous boosters with ChAdOx1 nCoV-19 (COVISHIELD™) or BBV152 (COVAXIN®), the two vaccines used widely for primary immunization in India, in participants who had already received two primary doses of these vaccines. Participants primed with two doses each of COVISHIELD™ or COVAXIN® 12-36 weeks previously, were randomised to receive either COVISHIELD™ or COVAXIN® booster in a 1:1 ratio. The primary outcome was day 28 post-booster anti-spike IgG seropositivity and secondary outcomes were anti-spike IgG levels and assessment of safety and reactogenicity. The results of 90 days intention-to-treat analysis are presented. This trial is registered with ISRCTN (CTRI/2021/08/035648). In the COVISHIELD™ primed group with 200 participants, the seropositivity 28 days post booster in the heterologous COVAXIN® arm was 99% and non-inferior to the homologous COVISHIELD™ arm, which was also 99% (difference 0%; 95% CI:-2.8% to 2.7%). The geometric mean concentration (GMC) of anti-spike antibodies following heterologous COVAXIN® boost on day 28 was 36,190.78 AU/mL (95% CI: 30,526.64-42,905.88) while the GMC following homologous COVISHIELD™ boost was 97,445.09 AU/mL (82,626.97-114,920.7). In the COVAXIN® primed group with 204 participants, the seropositivity 28 days post booster in the heterologous COVISHIELD™ arm was 100% and non inferior to the homologous COVAXIN® arm which was 96% (difference 4%, 95% CI: 0.2%-7.8%). The GMC following heterologous COVISHIELD™ boost was 241,681.6 AU/mL (95% CI: 201,380.2-290,048.3) compared to homologous COVAXIN® boost, which was 48,473.94 AU/mL (95% CI: 38,529.56-60,984.95). The day 28 geometric mean ratio (GMR) of the anti-spike IgG between the heterologous and homologous boosted arms was 0.42 (95% CI: 0.34-0.52) in the COVISHIELD™ primed group and 5.11 (95% CI: 3.83-6.81) in the COVAXIN® primed group. There were no related serious adverse events reported in any group. Homologous and heterologous boosting with COVISHIELD™ or COVAXIN® in COVISHIELD™ or COVAXIN® primed individuals are immunogenic and safe. A heterologous boost with COVISHIELD™ after COVAXIN® prime offers the best immune response among the four combinations evaluated. Azim Premji Foundation and Bill and Melinda Gates Foundation.

Income-related Inequity in Child Immunisation in India: Accounting for Horizontal and Vertical Inequity

Income-related Inequity in Child Immunisation in India: Accounting for Horizontal and Vertical Inequity

Income-Related Inequity in Child Immunization in India: Accounting for Horizontal and Vertical Inequity

Income-Related Inequity in Child Immunization in India: Accounting for Horizontal and Vertical Inequity

Exploring the genetic landscape of diphtheria, tetanus and pertussis vaccination-associated seizures or subsequent epilepsies

Diphtheria, Tetanus, and whole-cell Pertussis (DTwP) vaccination-associated seizures form the commonest type of serious adverse event following immunization in India and are an important reason for vaccine hesitancy. Our study explored the genetic explanation of DTwP vaccination-associated seizures or subsequent epilepsies. Between March 2017 and March 2019, we screened 67 children with DTwP vaccination-associated seizures or subsequent epilepsies, and of those, we studied 54 without prior seizures or neurodevelopmental deficits. Our study design was cross-sectional with a 1-year follow-up having both retrospective and prospective cases. We performed clinical exome sequencing focused on 157 epilepsy-associated genes and multiplex ligation-dependent probe amplification of the SCN1A gene at enrolment. We applied the Vineland Social Maturity Scale for neurodevelopmental assessment at follow-up. Of 54 children enrolled and underwent genetic testing (median age 37.5 months, interquartile range 7.7–67.2; diagnosis at enrolment: epilepsy 29, febrile seizure 21, and febrile seizure-plus 4), we found 33 pathogenic variants of 12 genes. Of 33 variants, 13 (39%) were novel. Most pathogenic variants were found in SCN1A gene (n = 21/33; 64%), SCN8A in 2 children, and 10 children had one variant in CDKL5 , DEPDC5 , GNAO1 , KCNA2 , KCNT1 , KCNQ2 , NPRL3 , PCDH19 , RHOBTB2 , and SLC2A1 . Five or more seizures (odds ratio [OR] = 5.3, confidence interval [CI]: 1.6–18.4, p = 0.006), drug-resistant epilepsy (OR = 9.8, 95% CI: 2.6–30.7, p = 0.001) and neurodevelopmental impairment (social quotient < 70) (OR = 5.6, 95% CI: 1.65–17.6, p = 0.006) were significant predictors of genetic diagnosis. Our study provides proof-of-concept for genetic aetiology in children with DTwP vaccination-associated seizures or subsequent epilepsies and has important implications for vaccination policies in developing countries. International Pediatric Association Foundation, Inc. (IPAF): İhsan Doğramaci research award 2016/2017; Indian Council of Medical Research (ICMR), New Delhi, India: No.3/1/3/JRF-2016/HRD/LS/71/10940.

The effect of the COVID-19 pandemic on routine childhood immunization coverage and timeliness in India: retrospective analysis of the National Family Health Survey of 2019-2021 data.

BackgroundThe COVID-19 pandemic has disrupted health systems globally. We estimated the effect of the pandemic on the coverage and timeliness of routine childhood immunization in India through April 2021.MethodsWe used data from India’s National Family Health Survey 2019-2021 (NFHS-5), a cross-sectional survey which collected immunization information of under-five children from a nationally representative sample of households between June 2019 and April 2021. We used a mother fixed-effects regression model – accounting for secular trends and confounding factors – to compare COVID-affected children with their COVID-unaffected siblings (n=59,144). Children who were eligible for a vaccine after January 30, 2020 (date of the first COVID case in India) were considered as the COVID-affected group and those eligible for a vaccine after this date were included in the COVID-unaffected group. Coverage of the following vaccine doses was considered—Bacillus Calmette–Guérin (BCG), hepatitis B birth dose (hepB0), DPT1 (diphtheria, pertussis, and tetanus, first dose), DPT2, DPT3, polio1, polio2, polio3, and measles first dose (MCV1). Indicators of vaccine coverage and vaccine timeliness (defined as receiving a dose within 45 days of minimum eligibility age) were separately examined.FindingsImmunization coverage was lower in COVID-affected children as compared with unaffected children, ranging from 2% lower for BCG and hepB0 to 9% for DPT3 and 10% for polio3. There was no significant difference in MCV1 coverage. Coverage reduction was greater for vaccines doses given at later age groups. The rate of timely receipt of polio and DPT vaccine doses was 3%-5% lower among COVID-affected children relative to unaffected children. Among population subgroups, COVID-affected male children and those from rural areas experienced the highest reduction in vaccine coverage.InterpretationChildren in India experienced lower routine immunization coverage and greater delays in immunization during the COVID-19 pandemic.FundingThe Bill & Melinda Gates Foundation.

Safety and immunogenicity of the Rotavac and Rotasiil rotavirus vaccines administered in an interchangeable dosing schedule among healthy Indian infants: a multicentre, open-label, randomised, controlled, phase 4, non-inferiority trial

BackgroundRotavirus is the leading cause of severe dehydrating gastroenteritis among children younger than 5 years in low-income and middle-income countries. Two vaccines—Rotavac and Rotasiil—are used in routine immunisation in India. The safety and immunogenicity of these vaccines administered in a mixed regimen is not documented. We therefore aimed to compare the safety and seroresponse of recipients of a mixed regimen versus a single regimen.MethodsWe did a multicentre, open-label, randomised, controlled, phase 4, non-inferiority trial at two sites in India. We recruited healthy infants aged 6–8 weeks. Infants with systemic disorders, weight-for-height Z scores of less than minus three SDs, or a history of persistent diarrhoea were excluded. Eligible infants were randomly allocated to six groups in equal numbers to receive either the single vaccine regimen (ie, Rotavac–Rotavac–Rotavac [group 1] or Rotasiil–Rotasiil–Rotasiil [group 2]) or the mixed vaccine regimen (ie, Rotavac–Rotasiil–Rotavac [group 3], Rotasiil–Rotavac–Rotasiil [group 4], Rotavac–Rotasiil–Rotasiil [group 5], or Rotasiil–Rotavac–Rotavac [group 6]). Randomisation was done using an online software by site in blocks of at least 12. The primary outcome was seroresponse to rotavirus vaccine, measured using rotavirus-specific serum IgA antibodies 4 weeks after the third dose. The seroresponse rates were compared between recipients of the four mixed vaccine regimens (consisting of various combinations of Rotavac and Rotasiil) with recipients of the single vaccine regimens (consisting of Rotavac or Rotasiil only for all three doses). The non-inferiority margin was set at 10%. Safety follow-ups were done for the duration of study participation. This trial was registered with the Clinical Trials Registry India, number CTRI/2018/08/015317.FindingsBetween March 25, 2019, and Jan 15, 2020, a total of 1979 eligible infants were randomly assigned to receive a single vaccine regimen (n=659; 329 in group 1 and 330 in group 2) or a mixed vaccine regimen (n=1320; 329 each in groups 3 and 4, and 331 each in groups 5 and 6). All eligible participants received the first dose, 1925 (97·3%) of 1979 received the second dose, and 1894 (95·7%) received all three doses of vaccine. 1852 (93·6%) of 1979 participants completed the follow-up. The immunogenicity analysis consisted of 1839 infants (1238 [67·3%] in the mixed vaccine regimen and 601 [32·7%] in the single vaccine regimen; 13 samples were insufficient in quantity) who completed vaccination and provided post-vaccination sera. The seroresponse rate in the mixed vaccine regimen group (33·5% [95% CI 30·9–36·2]) was non-inferior compared with the single vaccine regimen group (29·6% [26·1–33·4]); the seroresponse rate difference was 3·9% (95% CI −0·7 to 8·3). The proportion of participants with any type of solicited adverse events was 90·9% (95% CI 88·4–93·0) in the single vaccine regimen group and 91·1% (89·5–92·6) in the mixed vaccine regimen group. No vaccine-related serious adverse events or intussusception were reported during the study.InterpretationRotavac and Rotasiil can be safely used in an interchangeable manner for routine immunisation since the seroresponse was non-inferior in the mixed vaccine regimen compared with the single vaccine regimen. These results allow for flexibility in administering the vaccines, helping to overcome vaccine shortages and supply chain issues, and targeting migrant populations easily.FundingMinistry of Health and Family Welfare, Government of India.TranslationFor the Hindi translation of the abstract see Supplementary Materials section.

Maternal Exposure to Intimate Partner Violence and Child Immunisation: Insights from a Population-based Study in India

Child immunisation is regarded as one of the most essential public health interventions for reducing morbidity and mortality among children. Despite several public healthcare initiatives, a considerable proportion of children are yet to be covered under vaccination service in India. This study attempts to examine the association between maternal exposure to intimate partner violence (IPV) and childhood immunisation in India. Data were drawn from the fourth round of the National Family Health Survey (NFHS-4), conducted in 2015–16. Bivariate and multivariate logistic regression models were employed to assess the associations. About 65% of sample children aged 11–23 months were fully vaccinated. After adjusting for socio-demographic factors, women’s exposure to emotional IPV was significantly associated with a lower likelihood of full immunisation (adjusted odds ratio [AOR]: 0.74, 95% confidence interval [CI]: 0.61–0.90) among children. However, physical and sexual IPV had no significant association with childhood immunisation status in the adjusted analysis. The findings suggest preventive measures against domestic violence to reduce the risk of poor child healthcare services. Furthermore, efforts should be taken for effective reproductive and child healthcare programmes, especially among socio-economically vulnerable women and children, to improve child vaccination coverage.

Public finance of universal routine childhood immunization in India: district-level cost estimates.

India’s Universal Immunization Programme (UIP) is among the largest routine childhood vaccination programmes in the world. However, only an estimated 65% of Indian children under the age 2 years were fully vaccinated in 2019. We estimated the cost of raising childhood vaccination coverage to a minimum of 90% in each district in India. We obtained vaccine price data from India’s comprehensive multi-year strategic plan for immunization. Cost of vaccine delivery by district was derived from a 2018 field study in 24 districts. We used propensity score matching methods to match the remaining Indian districts with these 24, based on indicators from the National Family Health Survey (2015–16). We assumed the same unit cost of vaccine delivery in matched pair districts and estimated the total and incremental cost of providing routine vaccines to 90% of the current cohort of children in each district. The estimated national cost of providing basic vaccinations—one dose each of Bacillus Calmette–Guerin (BCG) and measles vaccines, and three doses each of oral polio (OPV) and diphtheria, pertussis and tetanus vaccines—was $784.91 million (2020 US$). Considering all childhood vaccines included in UIP during 2018–22 (one dose each of BCG, hepatitis B and measles–rubella; four doses of OPV; two doses of inactivated polio; and three doses each of rotavirus, pneumococcal and pentavalent vaccines), the estimated national cost of vaccines and delivery to 90% of target children in each district was $1.73 billion. The 2018 UIP budget for vaccinating children, pregnant women and adults was $1.17 billion (2020 US$). In comparison, $1.73 billion would be needed to vaccinate 90% of children in all Indian districts with the recommended schedule of routine childhood vaccines. Additional costs for infrastructural investments and communication activities, not incorporated in this study, may also be necessary.

Leaving No Child Behind: Decomposing Socioeconomic Inequalities in Child Health for India and South Africa.

Background: The United Nations’ 2030 Agenda for Sustainable Development argues for the combating of health inequalities within and among countries, advocating for “leaving no one behind”. However, child mortality in developing countries is still high and mainly driven by lack of immunization, food insecurity and nutritional deficiency. The confounding problem is the existence of socioeconomic inequalities among the richest and poorest. Thus, comparing South Africa’s and India’s Demographic and Health Surveys (DHS) of 2015/16, this study examines socioeconomic inequalities in under-five children’s health and its associated factors using three child health indications: full immunization coverage, food insecurity and malnutrition. Methods: Erreygers Normalized concentration indices were computed to show how immunization coverage, food insecurity and malnutrition in children varied across socioeconomic groups (household wealth). Concentration curves were plotted to show the cumulative share of immunization coverage, food insecurity and malnutrition against the cumulative share of children ranked from poorest to richest. Subsequent decomposition analysis identified vital factors underpinning the observed socioeconomic inequalities. Results: The results confirm a strong socioeconomic gradient in food security and malnutrition in India and South Africa. However, while full childhood immunization in South Africa was pro-poor (−0.0236), in India, it was pro-rich (0.1640). Decomposed results reported socioeconomic status, residence, mother’s education, and mother’s age as primary drivers of health inequalities in full immunization, food security and nutrition among children in both countries. Conclusions: The main drivers of the socioeconomic inequalities in both countries across the child health outcomes (full immunization, food insecurity and malnutrition) are socioeconomic status, residence, mother’s education, and mother’s age. In conclusion, if socioeconomic inequalities in children’s health especially food insecurity and malnutrition in South Africa; food insecurity, malnutrition and immunization in India are not addressed then definitely “some under-five children will be left behind”.

Adult Immunization in India

Adult Immunization in India