Implementation Of Immunization Program Research Articles

Cost-effectiveness of the 20-valent pneumococcal conjugate vaccine versus the 23-valent pneumococcal polysaccharide vaccine for older adults in South Korea

BackgroundDespite the demonstrated immunogenicity and safety of the 20-valent pneumococcal conjugate vaccine (PCV20) in older adults, the cost-effectiveness of the PCV20 was not examined compared to the 23-valent pneumococcal polysaccharide vaccine (PPSV23) in South Korea. Therefore, this study aimed to evaluate the cost-effectiveness of PCV20 compared with PPSV23 in adults aged 65 years and older in South Korea. MethodsWe constructed a Markov model that included susceptible states, invasive pneumococcal disease (IPD), non-bacteremic pneumonia (NBP), and death. The population was categorized by disease risk status (low risk, moderate risk, and high risk) and age group (65–74/75–84/85–99 years) at model entry. The annual incidence and mortality of IPD and NBP associated with PCV20 and PPSV23 were estimated based on serotype coverage, vaccine coverage, and vaccine effectiveness. The disease costs and utilities were obtained from previous studies. The incremental cost-effectiveness ratio (ICER) was used to evaluate cost-effectiveness within the threshold of 16,824 USD per quality-adjusted life-year (QALY). ResultsAmong the total population (n = 8,843,072), PCV20 prevented 1941 and 50,575 cases of IPDs and NBPs, respectively, and 898 and 8593 deaths due to IPDs and NBPs compared to PPSV23. The total medical cost per person was 12.11 USD higher in PCV20, with a gain of 0.0053 LYs and 0.0045 QALYs per person. The ICER for PCV20 and PPSV23 was 2270 USD/LY and 2677 USD/QALY. ConclusionsIn South Korea, PCV20 is a cost-effective option compared with PPSV23 for adults aged 65 years and older. These cost-effectiveness results provide evidence for decision-making regarding the approval and National Immunization Program implementation of PCV20.

Immunization Program Implementation as the Effort to Achieve Universal Child Immunization (UCI)

Immunization Program Implementation as the Effort to Achieve Universal Child Immunization (UCI)

Assessment of Factors Influencing the Implementation of Immunization Programmes in Bauchi Metropolis

The study is an Assessment of the factors influencing the implementation of Immunization programmes in Bauchi Metropolis. The specific objective of the study were to find out the factors influencing the implementation of Immunization programmes in Bauchi Metropolis, and to determine the ways to improve implementing immunization programmes in Bauchi Metropolis. The design for this study was the descriptive survey. The population was 6427 mothers and caregivers of which 361 were sampled using simple random sampling technique. The instrument for data collection is a structured questionnaire designed to elicit responses to answer the research questions that guided the study. The instrument was validated by three experts in terms of face validity while test re-test was use to establish the reliability coefficient of the instrument which yielded a coefficient of 0.84. Data for the study were personally collected by the researcher and 3 research assistants while mean statistics was employed to analyzed the data relating to research questions. Based on the findings of the study, the following recommendation were made: Government should re-strategize methods of creating awareness to change bad perceptions and practices on RI among people of the state, Bauchi State Ministry of Education and Agency for Mass Education should collaborate to improve the literacy level of the people, State Ministry of Education should create convenient adult education classes to improve educational status of mothers and Bauchi State government should divert resources specially for girl-child education in the state.

Assessment of immunization session practices in primary health care centers in Al-Najaf province.

Immunization has played a vital role in improving global health by reducing the transmission of infectious diseases. To ensure the successful implementation of immunization programs, it is crucial to thoroughly examine various elements within the Primary Health Care Centers, including immunization session management, cold-chain and logistics management, supervision, and reporting. The study aims to assess the immunization session practices in selected primary healthcare centers in Al-Najaf governorate. A descriptive cross-sectional study was conducted at 26 primary healthcare centers, selected using simple random sampling, across six districts in Najaf governorate. A total of 143 healthcare workers, comprising 122 vaccinators and 21 doctors, were included in the study. questionnaires were utilized to assess immunization session practices. Data collection commenced on December 2, 2022, and concluded on March 2, 2023. Immunization session practices were evaluated as having poor vaccine and diluent management, fair cold chain management, communication with clients and caregivers, vaccine preparation and administration practices, and waste management practices. However, immunization session equipment availability, as well as card review and registration during immunization, received good evaluations. The overall assessment of immunization session practices was determined to be fair. In addition, the study identified significant associations between immunization practices and the number of non-vaccinators working in the immunization unit (P=0.035), and the average number of daily vaccine recipients in primary healthcare centers (P=0.046). The immunization session practices achieved a fair level of assessment, The increased number of daily visitors to the immunization unit and the number of health workers who are non-vaccinator in the unit affected negatively the immunization session practices.

Effect of Access to Immunization Information on Vaccine Acceptance amongst Parents/Caregivers Visiting Health Facilities in Wushishi Local Government Area, Niger State

Globally, vaccines are the most cost-effective medical intervention to prevent death and disease. The objectives of this study were to assess the effect of access to immunization information on vaccine acceptance amongst parents/caregivers visiting the major health facilities within Wushishi Local Government Area, Niger State. A semi-structured interviewer-administered questionnaire was used for this study. The result of the study showed a mean age of respondents was 26.88 years. 96.5% of the respondents were females, 45.5% had no formal education, 30.7% were unemployed, and 35.5% were of Hausa ethnicity. 65.1% of respondents obtain information on routine immunization within 12 months before the study. 54.5% had satisfactory knowledge of immunization, while 71.5% exhibited a favorable attitude toward immunization. The major source of information was health workers. Those who had access to information were more likely to have good knowledge of immunization (X2=127.246, DF=1, p=0.001) and a more favorable attitude towards immunization (X2=14.155, DF=1, p=0.001). This study has demonstrated that access to information on immunization greatly affects the knowledge and, consequently, the attitude of parents toward making a positive decision to accept vaccination. Efforts should be made to understand the content and effect of information sources on knowledge and attitudes toward vaccination by relevant stakeholders involved in the implementation of immunization programs. Keywords: Access to immunization, Access to immunization information, Vaccine acceptance.

Influence of Leadership Behavior and Management Process on Immunization Program Implementation

Background: Indonesia is still ranked 4th in the world for having low DPT3 immunization coverage among children. Complete basic immunization coverage is targeted at 95% according to the strategic plan of Indonesian Ministry of Health, but it still achieves at 91.1%. This study aims to analyze leader behavior and health center management on immunization program implementation.Method: Quantitative research using a cross-sectional design was conducted at the Puskesmas Biru-Biru Deli Primary Healthcare Center, Serdang District. The research population and samples consist of 122 respondents which include all 121 midwives in 17 villages and one person in charge of immunization services. The survey data were analyzed using the chi-square test and logistic regression test.Results: The chi-square test showed an influence of leadership behavior and management process on immunization program implementation (p = 0.000). In the last stage of logistic regression analysis, one variable that most dominantly affected the program implementation is management process (p = 0.0000; OR = 25,497; 95% CI = 6.475-100.406). The primary healthcare center needs to improve leader’s behavior and management process.

Adverse effects followed by immunization with COVISHIELD and COVAXIN among health care personnel in a tertiary care hospital of India

The ongoing Corona Virus Disease (COVID-19) is a pandemic disease adversely affecting health and also incurred severe financial losses globally. Vaccination is the important preventing measure to combat COVID-19 infection. Vaccine hesitancy due to the fear of side effects is a major drawback for successful implementation of immunization programs. Extensive studies on safety of COVID-19 vaccination are much needed to address this problem. The current study aims at evaluating adverse effects following vaccination against COVID-19 infection. A total of 584 healthcare personnel who received either COVISHIELD or COVAXIN were included in the study. The adverse effects after first and second dose of vaccines in different time intervals (<24hrs, 24-48hrs, 3-7days) were recorded by using World Health Organization (WHO) based questionnaire. Among the participants, 360 received COVISHIELD and 220 received COVAXIN vaccine. Majority of the subjects experienced side effects within first 24hrs of first dose (COVISHIELD 84%, COVAXIN 90%) and also of second dose (COVISHIELD 73%, COVAXIN 89%). Side effects like general weakness, headache, fever, chills and myalgia were the most common side effects observed with both vaccines.

Adverse Events Following Immunization with SARS-CoV-2 Vaccines and its Reporting in India: A Growing Concern

The COVID-19 pandemic has led to many drug delivery systems and vaccine developments globally. Implementation of immunization programs has been done through emergency approvals and has also raised concerns regarding side effects and adverse events following immunization. The side effects are fever, injection site pain, arthralgia, redness, swelling, induration, pruritus, myalgia, induration, chills, headache, vomiting, and fatigue. The adverse events are anaphylaxis, thrombotic thrombocytopenic purpura, intracranial venous sinus thrombosis, Guillain–Barre syndrome, seizures, Steven–Johnson Syndrome, pulmonary embolism, acute myocardial infarction, myocarditis, and pericarditis associated with different vaccines. The factsheet of many vaccines does not convey sufficient details to alert the beneficiaries. These need to be updated timely and beneficiaries need to be made aware of the same. In some countries, authorized portals have captured these data on a real time basis. Similar portals need to be in place in India also so that data generated can be used for further timely recognition, reporting, and management of AEFI. The reporting of the same should be made mandatory for all and guidance should be provided regarding levels of management, home based, or hospital based.

Re-verifying the elimination of measles, rubella and congenital rubella syndrome in Canada, 2016-2020.

Elimination, in the context of measles, rubella and congenital rubella syndrome (CRS), refers to the absence of endemic measles/rubella virus transmission in a region or other defined geographic area for at least 12 months, in the presence of a high-quality surveillance system that meets targets of key performance indicators. In 1994, Canada and other countries of the World Health Organization (WHO) region of the Americas committed to the objectives of measles elimination by 2000 and rubella and CRS by 2010. Canada met these targets: eliminating measles transmission in 1998; rubella transmission in 2005; and endemically-acquired CRS in 2000. The WHO region of Americas was declared free of endemic rubella/CRS in 2015 and endemic measles in 2016. At the request of the Pan American Health Organization (PAHO), Canada’s elimination status of measles, rubella and CRS was verified in 2012 and again in 2017. Prior to submission to PAHO, the verification reports were reviewed, approved and endorsed by Canada’s National Certification Committee (NCC). The NCC is a group of experts who are not directly involved with the management of vaccine preventable diseases or immunization program implementation at the national level, but who have the expertise to assist in ensuring that Canada is meeting PAHO’S goals of elimination and eradication. Members are responsible for reviewing Canada’s current mechanisms of surveillance and progress towards elimination of targeted vaccine preventable diseases in Canada. Members have expertise in the fields of public health, infectious diseases and/or laboratory sciences.

Toxin-associated infectious diseases: tetanus, botulism and diphtheria.

The incidence rates of the toxin-related infectious diseases, tetanus, diphtheria and botulism declined dramatically over the past decades mainly because of the implementation of immunization programs also in low-and-middle-income countries (LAMICs) and by improving hygiene conditions. But still, single cases occur, and they need fastest possible recognition and management. Over the past 20 years, the incidence of neonatal tetanus has declined by more than 90%. This success was achieved by immunizing women in reproductive age in areas of high risk as sub-Saharan Africa and parts of Asia. Larger regional outbreaks of diphtheria have been reported from the former Soviet Union in the 1990s and from India in 2017. Botulism is still rare, mainly seen in infants and, in recent years, in intravenous drug abusers. Tetanus, diphtheria and botulism are rarities in high-income countries (HICs) with unlimited access to immunization programs and standard hygiene procedures. The diagnosis of all three diseases is still, even in the 21st century, based upon patient's history and clinical signs and symptoms. Neither biochemical bedside tests nor neuroradiological investigations help to confirm the diagnosis in an emergency situation.

Determinants of Full Vaccination Status in Children Attending Immunization Clinic in a Tertiary Hospital in Benin City, Nigeria

Immunization is a cost-effective approach aimed at improving child survival. Coverage is an indicator to monitor the progress towards achieving child survival and the strategy to reduce childhood morbidity and mortality. The study was a descriptive cross-sectional study among 300 mothers /caregivers attending a tertiary institution clinic for immunization of the children using immunization card and verbal response of the mother. Findings from the study showed that 220 (73.3%) of the index children were fully vaccinated for age while 80 (26.7%) were not. BCG was the commonest vaccine received by the respondents as 280 (93.3%) received it, followed by OPV, 261 (87.0%) and Pentavalent vaccine, 246 (82.0%). Majority of the index children were vaccinated for age with high BCG, OPV and Pentavalent vaccine coverage rates. Socio-demographic factors that influenced the utilization of immunization included the mothers’ level of education, occupation, reception of antenatal care. A better understanding of the immunization schedule is important in the design and implementation of immunization programmes. Educating mothers about vaccines and vaccine preventable diseases are recommended.
 Keywords: determinants, vaccination, tertiary hospital, childhood

Efficacy after 1 and 2 doses of CYD-TDV in dengue endemic areas by dengue serostatus

A simplified dose regimen of the live, attenuated, tetravalent dengue vaccine (CYD-TDV) could have the potential to facilitate easier implementation of immunization programs against symptomatic virologically-confirmed dengue (VCD) in dengue seropositive individuals aged ≥ 9 years. This post-hoc analysis of two Phase III studies (CYD14 [NCT01373281] and CYD15 [NCT01374516]) in dengue endemic areas assessed the efficacy of CYD-TDV by dengue serostatus between dose 1 and 2 (at Month [M] 6), between dose 2 and 3 (at M12), and from dose 3 to M25. Baseline dengue serostatus (seropositive or seronegative) was determined based on measured dengue neutralizing antibody titers with the 50% plaque reduction neutralization test (PRNT50) or ascertained by logistic regression-based multiple imputation (MI) to predict PRNT50. Vaccine efficacy against symptomatic VCD was assessed by age and baseline dengue serostatus using a case-cohort framework. Dengue neutralizing antibody geometric mean titers (GMTs) were measured with the PRNT50 at 28 days post-dose 2 and 3. Vaccine efficacy estimates in seropositive participants aged ≥ 9 years at post-dose 1, 2, and 3 were 80.5% (95% CI, 66.2, 88.7), 82.0% (95% CI, 70.5, 89.0), and 75.2% (95% CI, 65.9, 81.9), respectively. In seropositive participants aged < 9 years, vaccine efficacy estimates were 48.5% (95% CI, –24.3, 78.6), 68.3% (95% CI, 34.5, 84.7), and 65.3% (95% CI, 40.2, 79.9), respectively. CYD-TDV efficacy was null to modest after any dose in seronegative participants, regardless of age group. Seropositive participants aged ≥ 9 years in the CYD-TDV group had GMTs post-dose 3 that did not exceed those observed post-dose 2. In conclusion, CYD-TDV has high efficacy against VCD from the first dose through to M25, with estimates at post-dose 1 and 2 similar to or higher than those at post-dose 3 in seropositive participants aged ≥ 9 years, consistent with immunogenicity data.

Funding and Implementation of National Programme on Immunization in Nigeria: Case Study of Bekwarra Local Government Area, Cross River State

This study investigated how funding has affected effective implementation of National Programme on Immunization (NPI) in Bekwarra Local Government of Cross River State, Nigeria from 2003-2016. To achieve this objective, a research hypothesis was formulated. A total of 200 Health workers were randomly selected using survey inferential research design from the population of 320 Health workers in the study area. A well validated Likert type scale instrument called Immunization Related Issues Questionnaire (IRIQ) consisting of 22 items with a reliability index of 0.84 was the instrument for data collection. Data collected from the respondents were subjected to the Chi-Suare statistics to test the hypothesis in the study. The result of the test was significant at 0.05 level and it was concluded that funding significantly influences effective implementation of immunization programme in Bekwarra Local Government Area. The study noted that adequate funds are not provided for effective implementation of National Programme on Immunization (NPI), and whenever funds are provided, it is often mismanaged. Also, it was revealed that non-governmental organization (NGOs) should assist in funding immunization programme by providing logistics and technical equipment for effective programme implementation. It was recommended among others that both the government and health donor agencies should provide adequate funds for effective implementation of immunization programmes. Also, there should be a proper monitoring mechanism for utilization of funds meant for Immunization programmes.

Evaluating Variability in Immunization Requirements and Policy Among U.S. Colleges and Universities

ObjectivesTo evaluate variation in vaccine requirements, recommendations, and enforcement strategies among U.S. four-year colleges and universities. MethodsWe conducted a cross-sectional study abstracting information from Web sites among a sample of 216 four-year colleges and universities from all 50 states and District of Columbia. Our primary outcomes of interest included: type and number of vaccines required for school entry, vaccines recommended by schools for students, and vaccines supplied through student health services. Covariates of interest included: school type, region, school size, mention of American College Health Association recommendations, presence of an accredited health center, mention of state requirements, presence of an enforcement strategy, and exemption stringency of the state in which the school was located. ResultsAlmost all (94%) schools required at least one vaccine for school entry, and 48% required three or more vaccines. The most commonly required vaccines were measles, mumps, and rubella (88.4%) and meningococcal vaccine (51.9%). All schools required the same vaccines included in state requirements but 65% also required additional vaccines. Most schools (67.1%) used registration hold to enforce requirements, while 14.8% restricted students from campus housing and 2.8% dismissed noncompliant students. Seventeen percent of schools had no published enforcement strategies. A higher proportion of private compared to public universities required three or more vaccines (57% vs. 37.3%, p = .014). ConclusionsWhile most schools have immunization requirements, there is significant variation in number and type of vaccines required. This suggests potential inconsistent uptake of recommended vaccines for college students and underlies the need to characterize facilitators and barriers to immunization program implementation on college campuses.

Rotavirus genotypes circulating in Ontario, Canada, before and after implementation of the rotavirus immunization program

Background and objectivesOntario introduced a universal publicly-funded group A rotavirus (RVA) immunization program in August 2011, using monovalent vaccine. RVA immunization programs have decreased the incidence of RVA acute gastroenteritis in many countries but it is unclear if it will contribute to the emergence of certain genotypes. We monitored RVA trends and genotypes in Ontario before and after implementation of the publicly-funded immunization program. MethodsRVA detection was conducted at Public Health Ontario Laboratories from January 2009 to December 2011 (pre-program period) and January 2012 to October 2015 (publicly-funded RVA immunization program period) and number of RVA-positive specimens and percent positivity were analysed. A convenience sample of RVA-positive stool specimens, from September 2010 to December 2011 (pre-program period) and January 2012 to June 2013 (program period), were genotyped using heminested PCR. A literature review on the burden of illness from emergent genotype was performed. ResultsStool specimens showed a significant decrease in RVA percent positivity from the 36 month pre-program period (14.4%; 1537/10700) to the 46 month program period (6.1%; 548/9019). An increase in the proportion of RVA G10 among genotyped specimens, associated with five different P genotypes, from the pre-program (6.3%; 13/205) to the program (31.5%; 40/127) period was observed. Our literature review identified approximately 200 G10-positive human stool specimens from 16 different countries. ConclusionsThis study documented a decrease in the number of RVA-positive specimens and percent positivity after implementation of the immunization program. An unexpected increase in the proportion of RVA G10 was detected following program introduction. Ongoing RVA surveillance is important in evaluating both the long-term impact of immunization and emergence of RVA genotypes.

The impact of access to immunization information on vaccine acceptance in three countries.

IntroductionVaccine acceptance is a critical component of sustainable immunization programs, yet rates of vaccine hesitancy are rising. Increased access to misinformation through media and anti-vaccine advocacy is an important contributor to hesitancy in the United States and other high-income nations with robust immunization programs. Little is known about the content and effect of information sources on attitudes toward vaccination in settings with rapidly changing or unstable immunization programs.ObjectiveThe objective of this study was to explore knowledge and attitudes regarding vaccines and vaccine-preventable diseases among caregivers and immunization providers in Botswana, the Dominican Republic, and Greece and examine how access to information impacts reported vaccine acceptance.MethodsWe conducted 37 focus groups and 14 semi-structured interviews with 96 providers and 153 caregivers in Botswana, the Dominican Republic, and Greece. Focus groups were conducted in Setswana, English, Spanish, or Greek; digitally recorded; and transcribed. Transcripts were translated into English, coded in qualitative data analysis software (NVivo 10, QSR International, Melbourne, Australia), and analyzed for common themes.ResultsDominant themes in all three countries included identification of health care providers or medical literature as the primary source of vaccine information, yet participants reported insufficient communication about vaccines was available. Comments about level of trust in the health care system and government contrasted between sites, with the highest level of trust reported in Botswana but lower levels of trust in Greece.ConclusionsIn Botswana, the Dominican Republic, and Greece, participants expressed reliance on health care providers for information and demonstrated a need for more communication about vaccines. Trust in the government and health care system influenced vaccine acceptance differently in each country, demonstrating the need for country-specific data that focus on vaccine acceptance to fully understand which drivers can be leveraged to improve implementation of immunization programs.

Serosurveillance of hepatitis A in a region which adopted the universal mass vaccination.

Hepatitis A is a common infectious disease worldwide that was endemic in many regions of Southern Italy, such as Apulia region. After a large hepatitis A outbreak occurred between 1996 and 1997, in Apulia an active-free immunization program that was targeted to new-borns and adolescents was started. The aim of this study is to investigate the hepatitis A seroprevalence in the adult Apulian population 18 years after the immunization program introduction, in order to evaluate the risk of new epidemics onset.The study was carried out from May 2011 to June 2012 among blood donors from Department of Transfusion Medicine and Blood Bank of Policlinico General Hospital in Bari. Participants signed a written consent and filled out a questionnaire including items on demographic characteristics, risk factors, disease memory, and raw food consumption. Serum samples, collected from each patient, were tested for anti-HAV using the chemiluminescent microparticle immunoassay. Vaccination status against hepatitis A was checked on Regional Digital Immunization Registry (GIAVA).In total 1827 donors agreed to participate (77.7% male) with a mean age of 38.4 ± 11.7 years. However, 1172 (64.1%) donors were seropositive with no difference by sex. The highest proportion of seronegative subjects was in the 27 to 35 years age group. 91.8% of 1-dose vaccinated subjects (n = 190/207; 95%CI = 87.2–95.1) and 96.1% (n = 171/178; 95%CI = 92.1–98.1) of 2-doses vaccinated subjects were immune to the disease. Sensitivity of disease memory in unvaccinated subjects was 14.4% (95%CI = 12.2–16.7), specificity was 97.8% (95%CI = 96.3–98.8), positive predictive value was 91% (95%CI = 85.3–95), and negative predictive value was 42.6% (95%CI = 40–45.2). Raw seafood consumption in unvaccinated subjects was associated with the anti-HAV IgG positivity (OR = 2.1; 95%CI = 1.7–2.7; z = 7.4; P < 0.0001).The vaccination program seems to have changed the virus circulation pattern, with a higher seronegativity rate among subjects not included in the vaccination strategy: 67% of susceptible subjects were among younger people aged 27 to 35 years. Immunization program implementation with a catch-up strategy may be needed to avoid a possible increase of hepatitis A incidence and outbreaks in Apulia. Epidemiological surveillance should be continued and vaccination should actively be offer for free to all the cases contacts, in order to prevent new outbreaks onset.

Hospitalization rates for intussusception in children aged 0–59 months from 2009 to 2014 in Italy

ABSTRACTThe real cause of intussusception is not fully understood and a variety of conditions have been associated with it (Meckel diverticulum, polyps, duplication cysts, parasites, Henoch-Schönlein purpura, cystic fibrosis, hemolytic-uremic syndrome and infectious gastroenteritis). Furthermore few European countries, following WHO recommendation to monitor baseline incidence of intussusception before implementation of immunization program for rotavirus, used intussusception rate as a baseline value to compare the same figures in the period before and after introduction of vaccination. In this study, data of intussusception hospitalizations occurred among Italian children aged 0 through 59 months from 2009 to 2014 were analyzed.A total amount of 3,088 children were included, accounting for a hospitalization rate of 20.2 per 100,000. Overall, the hospitalization rate for intussusception had a slight increase in trend from 2009 to 2014 (18%). In particular children 0–11 months had a hospitalization rate higher than 12–59 months with an aggregate value of 36 Vs. 16 per 100,000 respectively. Among all children hospitalized for intussusception a total of 239 (7.7%) had also a previous or concomitant hospitalization for gastroenteritis.This study demonstrates that Italian hospitalizations for intussusception are increasing by time and the role played by different risk factors, including acute gastroenteritis, have to be investigated in the future. These data could be useful to monitor intussusception hospitalization in the perspective of anti-rotavirus vaccination introduction in Italy.

Immunization review meetings: "Low Hanging Fruit" for capacity building and data quality improvement?

IntroductionAlthough systematic program review meetings are common practice in many health and immunization programs, there is little documentation on their implementation and role. Adult education principles espouse opportunities for peer exchange to build capacity and cross-learning, for which review meetings have been a forum utilized in immunization programs for many years. This study describes the process and use of review meetings to build immunization technical capacity in four African countries since 2011.MethodsA longitudinal case study providing retrospective descriptive analysis and qualitative data collected on immunization program implementation and review meetings conducted within the years of 2011-2016 with district and facility health staff and technical partners from Ethiopia, Kenya, Tanzania and Uganda.ResultsBased on summarized findings and analyses from over 200 review meetings conducted in the four countries within the time period of 2011-2016, these meetings have been shown to be effective tools for improving immunization program performance and the capacity of health staff.ConclusionReview meetings (ideally conducted quarterly) provide health workers with beneficial and low cost opportunities for adult learning, including building skills in data analysis and review, which can be sustained at district and health facility levels. In combination with other performance improvement approaches implemented and supported in countries (such as supportive supervision, training, and on-the-job learning and assessment), review meetings can also contribute to achievement of immunization and health outcomes.

Hospital admissions for viral meningitis in children in England over five decades: a population-based observational study

A substantial reduction in bacterial meningitis has occurred in the UK following successful implementation of immunisation programmes. Most childhood meningitis in developed countries is now caused by viruses. Long-term trends in paediatric viral meningitis in England have not previously been reported. The objective of this study is to report on epidemiological trends over time in childhood viral meningitis in England. In this population-based observational study, we used routinely collected hospital discharge records from English National Health Service hospitals from 1968-2011 to analyse annual age-specific admission rates for viral meningitis, including specific viral aetiologies, in children younger than 15 years. We analysed hospital discharge records from Jan 1, 1968, to Dec 31, 2011. Hospital admission rates for viral meningitis from Jan 1, 1968, to Dec 31, 1985, varied annually, with a mean of 13·5 admissions per 100 000 children aged less than 15 years, per year (95% CI 13·0-14·0). Admission rates declined during the late 1980s, and the mean number of admissions from 1989-2011 was 5·2 per 100 000 per year (5·1-5·3). This decrease was entirely in children aged 1-14 years. Admission rates for infants aged less than 1 year increased since 2005, to 70·0 per 100 000 (63·7-76·2) in 2011, which was driven by an increase in admission of infants aged 90 days or less. In 1968-85, the majority of cases in children were in those aged 1-14 years (22 150 [89%] of 24 920 admissions). In 2007-11, 1716 (72%) of 2382 cases were in infants. Admissions for mumps-related meningitis almost disappeared following introduction of the measles-mumps-rubella (MMR) vaccine in 1988. Admissions with a specified viral aetiology have increased since 2000. Trends in viral meningitis admissions have changed substantially over the past 50 years, and probably reflect the impact of the MMR vaccine programme and the use of more sensitive diagnostic techniques. None.