Improve Immunization Coverage Research Articles

Epidemiological, Clinical, Biological and Therapeutic Profile of Bacterial Meningitis and Factors Associated with Lethality: A Retrospective Study in the Clinic Infectious and Tropical Diseases of Fann Hospital (2020-2023)

Introduction: Bacterial meningitis remains a major public health problem in Africa, with a persistently high incidence and case fatality. The objective of this study is to describe the epidemiological, clinical, biological and therapeutic profile of bacterial meningitis, and to identify the factors associated with lethality. Patients and Methods: A descriptive and analytical retrospective study was conducted from the records of patients hospitalized for bacterial meningitis at the SMIT in Fann January 2020 and December 31, 2023. A multivariate regression analysis, with a significance threshold set at 5%, was performed using R software version 4.2.0. Results: During the study period, we collected 138 inpatient records of patients hospitalised for bacterial meningitis, representing a hospital frequency of 3.06%. The median age of patients was 35 years with IQR: [27-52]. HIV infection (17.39%), high blood pressure (8.76%) and diabetes (8.03%) were the most common comorbidities. Cerebrospinal fluid (CSF) was clear in nearly half of the cases (49.28%), and cytology found a predominantly polynuclear neutrophil white blood cell count in 50% of cases. The median length of hospital stay was 10 days with IQI [7-17]. The most commonly used antibiotic was ceftriaxone, which was administered to 92.04% of patients. During hospitalization, 49 patients died, i.e., a case fatality rate of 35.51%. Factors associated with death were HIV infection (aOR= 3.09; 95% CI [1.05-9.57]), p-value=0,041, a Glasgow score < 13 (aOR: 3.62; 95% CI [1.57-8.57]), p-value=0,03 and CRP > 96 mg/L (aOR: 2.85; 95% CI [1.25-6.72]), p-value=0,013. Conclusion: Bacterial meningitis has a high lethality rate at the Clinic of infectious and tropical diseases of Fann Hospital. Improving immunization coverage, strengthening diagnostic capacity and early management could reduce this fatality.

Routine Immunization Microplanning Challenges and Opportunities in Low- and Middle-Income Countries: A Mixed-Method Landscape Analysis.

Microplanning is widely recognized as a critical tool for improving immunization coverage and equity and is considered a core component of routine immunization. However, there is limited evidence on how microplans are developed and implemented and the effectiveness of microplanning. As such, this study sought to review the existing evidence on implementation and institutionalization of microplanning; identify strategies to improve microplanning; and document evidence on new approaches to microplanning, including digitally enhanced and integrated microplanning. We employed a three-stage mixed-method approach. First, we conducted a literature review on microplanning for routine immunization. Second, we administered an online survey to gather insights into the factors that constrained and enabled microplanning in low-resource settings. Third, we conducted key informant interviews to better understand the barriers and enablers. We found a paucity of published literature describing the drivers and effectiveness of microplanning and how to sustain it over time. Our review indicates that factors at both the development and implementation stages influence implementation and whether the process is sustained over time. These include the level of community engagement and health care worker ownership, access to data, the complexity of the microplanning tools, and the extent to which supervisors follow up on the plans. Our review indicates that microplanning is successful when health care workers and communities are engaged in the development process. While these findings highlight the benefits of a 'bottom-up' approach to microplanning, this may be more resource-intensive, and there remains a need for more research on the costs and benefits.

Further analysis of determinants of Pentavalent and Measles immunizations dropouts among children under five years of age in Ethiopia from Mini-EDHS 2019

BackgroundGlobally, immunization prevents an estimated 2–3 million deaths from illnesses that can be prevented by vaccination. The predictors of Pentavalent and Measles immunization dropout were not investigated sufficiently. Therefore, this analysis was meant to determine the coverage, burden, and predictors of Pentavalent and Measles immunizations in Ethiopia.Materials and methodsThis study was a further analysis of the Mini Ethiopian Demographic Health Survey (EDHS) 2019, conducted with a nationally representative sample. In this study, immunization data was collected from a total sample of 3208 children of which 2004 (34.8%) children who received pentavalent 1 were considered for this study. Univariable, bi-variable, and multilevel mixed effect analysis was done using STATA version 17 Software. The mixed-effect model with the lowest AIC and BIC (information criteria) was chosen. A factor was designated as a significant predictor of immunization dropout if its p-value was less than 0.05 at 95% CI. The best-fitting model among the fitted models was ultimately chosen using the Akaike and Bayesian Information Criteria (AIC and BIC).ResultThe mean age of the head of the household was 37.6. The majority (68.9%) of the residents were from rural areas and of the total population, 64.9% have no formal education. Being residents of Afar increased the odds of dropping out by 3.28 (AOR = 3.28; 95% CI: 1.12, 9.56), whereas being residents of Addis Ababa reduced their odds of dropping out from prentavalent 3 by 68.1% (AOR = 0.319; 95% CI: 0.122, 0.833) compared to their Tigray counterparts. The dropout rate of Pentavalent 1 to measles 1 vaccination was 4.33 times higher among residents of Afar (AOR = 4.33; 95% CI: 1.38, 13.56). As the level of wealth increases, the quintile increases from poorer to richer compared to those in the poorest wealth quantile category, and marital status also affects the immunization dropout rate of their children.ConclusionsImmunization coverage of Ethiopian children was low and the dropout from pentavalent 1 and measles vaccination was high compared to the national and international targets to improve immunization coverage and reduce dropout. So different cost-effective interventions like Education provision for the community, decision-making facilitation, behavioral change support, and multi-system participation were required to increase vaccination coverage and reduce the vaccine dropout among children in Ethiopia.

Integrated Approaches for the Delivery of Maternal and Child Health Services with Childhood Immunization Programs in Low- and Middle-Income Countries: Systematic Review Update 2011-2020.

Background: The integration of maternal and child health services (MCH) with routine immunization is an important global health strategy, particularly in low- and middle-income countries (LMICs). However, evidence is lacking regarding the best practices for service integration and the effect of integration on immunization and linked health service outcomes. Methods: We searched publication databases and gray literature for articles published between 2011 and 2020 that include approaches to integrating MCH services with immunizations during the first two years of life in LMICs. Abstracts and full-text articles were screened for eligibility. For the included articles, data extraction and analysis examined the descriptive characteristics of studies, outcomes, and implementation considerations. Results: Among the 16,578 articles screened, 44 met the criteria for inclusion, representing 34 studies, of which 29 were from Africa. The commonly linked MCH services were family planning (24%), human immunodeficiency virus (HIV) diagnosis or care (21%), and malaria prevention or control (21%). Multiple integration strategies were typically used; the co-location of linked services (65%), the provision of extra services by immunization staff (41%), and/or the provision of extra information by immunization staff (41%) were the most common. In general, integration improved MCH service outcomes (76%) and was either beneficial (55%) or neutral for immunization (35%), with some examples in family planning, malaria, and HIV where integrated services were not beneficial. Important implementation considerations included the careful matching of target populations in service re-design, ensuring support from policy, logistics, and information systems, the provision of adequate training and support of staff to avoid overload, clear client communication regarding service integration, and the need to address community concerns. Conclusions: Integrating MCH services with routine immunization can expand linked services and improve immunization coverage. This study has identified key implementation considerations relevant to both childhood and adult vaccination programs. More research is needed regarding costs and client preferences.

Knowledge of Primiparous Mothers on Immunization of Children under three Years in Rawalakot, Azad Kashmir

Immunization was crucial aspect of preventing infectious diseases in early childhood. However, lack of knowledge among parents especially primiparous mothers, can hinder optimal immunization coverage. Objective: To assess and evaluate the knowledge level of primiparous mother regarding immunization and the factor influencing immunization status in children under three years. Methods: A cross-sectional study was conducted with a sample of 210 mothers at Combined Military Hospital, Rawalakot, Azad Kashmir, from April 2023 to February 2024, using consecutive sampling. Data were collected using an adapted questionnaire, which included a demographic section and 37 knowledge items. Analysis was done by using SPSS version 26.0, using descriptive statistics (frequency and percentage) and inferential statistics (Chi-Square test). Results: There was gap in literature about primiparous mothers’ knowledge and this study results showed that 27.6% had low, 50% had moderate, and 22.4% had high knowledge. Complete immunization was achieved for 60.5% of children, highlighting the need for improved awareness, especially among primiparous mothers. Higher education and employment were significantly linked to better knowledge (P < 0.001), with healthcare professionals being the main source (56.6%). The study provided crucial insights for the Ministry of Health and policymakers, demonstrating the need to enhance immunization campaigns by improving primiparous mothers' knowledge for better vaccine coverage. Conclusions: A significant portion of primiparous mothers had moderate to low knowledge about child immunization, contributing to incomplete vaccination rates. Enhanced education and awareness programs, particularly for less informed mothers, were essential to improve immunization coverage in Azad Kashmir.

An Analysis of Consumer Awareness Regarding Jan Aushadhi Kendras

India has made significant advancements in various health aspects, including an increase in the life expectancy of both men and women, low infant and maternal mortality rates, improved immunization coverage, and the elimination of diseases like polio and smallpox. According to the World Health Organization, around 5.8 million Indians succumb to diseases like diabetes, cancer, stroke, and heart and lung diseases. Non-communicable diseases (NCDs) pose a substantial health challenge in India, with one out of every four Indians dying before the age of 70 due to an NCD. The Indian healthcare system is grappling with rising healthcare costs, which disproportionately burden the poor, as well as the emergence of new diseases and non-communicable diseases. Approximately 100 million Indians fall into poverty each year due to high healthcare expenses, with out-of-pocket spending constituting over 50 percent of this burden. To reduce healthcare costs, the government has established Jan Aushadhi Kendras, which offer generic medicines with the same composition as branded ones at affordable prices. A recent study focused on identifying the key factors influencing the purchase of generic drugs from Jan Aushadhi medical stores, public awareness of these stores, and consumer satisfaction. The study found that 40 percent of the public is unaware of Jan Aushadhi, and consumers opt for generic medicines due to their affordability, even though the quality is lower than that of branded drugs. Jan Aushadhi Kendra is known for selling significant quantities of sanitary pads. While most consumers are satisfied with Jan Aushadhi products, some express dissatisfaction due to differences in quality and composition. Government agencies and health departments must enhance the quality of generic medicines and educate healthcare professionals and the general public about them.

An Analysis of Consumer Awareness Regarding Jan Aushadhi Kendras

India has made significant advancements in various health aspects, including an increase in the life expectancy of both men and women, low infant and maternal mortality rates, improved immunization coverage, and the elimination of diseases like polio and smallpox. According to the World Health Organization, around 5.8 million Indians succumb to diseases like diabetes, cancer, stroke, and heart and lung diseases. Non-communicable diseases (NCDs) pose a substantial health challenge in India, with one out of every four Indians dying before the age of 70 due to an NCD. The Indian healthcare system is grappling with rising healthcare costs, which disproportionately burden the poor, as well as the emergence of new diseases and non-communicable diseases. Approximately 100 million Indians fall into poverty each year due to high healthcare expenses, with out-of-pocket spending constituting over 50 percent of this burden. To reduce healthcare costs, the government has established Jan Aushadhi Kendras, which offer generic medicines with the same composition as branded ones at affordable prices. A recent study focused on identifying the key factors influencing the purchase of generic drugs from Jan Aushadhi medical stores, public awareness of these stores, and consumer satisfaction. The study found that 40 percent of the public is unaware of Jan Aushadhi, and consumers opt for generic medicines due to their affordability, even though the quality is lower than that of branded drugs. Jan Aushadhi Kendra is known for selling significant quantities of sanitary pads. While most consumers are satisfied with Jan Aushadhi products, some express dissatisfaction due to differences in quality and composition. Government agencies and health departments must enhance the quality of generic medicines and educate healthcare professionals and the general public about them.

Optimization of basic immunization coverage at Paku Alam

Background: Immunization plays a vital role in preventing infectious diseases, significantly reducing morbidity and mortality worldwide. Indonesia's national immunization program has been in place since 1956, focusing on vulnerable groups such as infants and pregnant women. However, despite these efforts, immunization rates in Paku Alam Village, South Kalimantan, remain suboptimal, with 90% of the target population yet to complete basic immunization in 2023. Factors contributing to this gap include misinformation, vaccine hesitancy, and low health literacy among the population. Case presentation: In Paku Alam Village, only 27 out of the 30 targeted children for the 2023 immunization program received partial immunizations, with none completing the full schedule by mid-year. Misinformation spread via social media, coupled with fears about vaccine side effects, has fueled parental reluctance to immunize. Midwives and healthcare workers have struggled to combat these challenges due to a lack of effective communication tools and deep-rooted distrust in the healthcare system. Discussion: Addressing the immunization gap in Paku Alam Village requires a multifaceted approach, including educational interventions tailored to parents. These interventions should include visual aids, interactive discussions, and community-based outreach to improve vaccine knowledge and trust. Additional strategies like offering incentives, collaborating with early childhood education centers, and strengthening healthcare worker training are also critical. Building trust through culturally appropriate messaging from trusted community leaders is essential to overcoming vaccine hesitancy. Conclusion: The immunization program in Paku Alam Village faces challenges rooted in low parental knowledge and the spread of misinformation. However, targeted health education, collaboration between healthcare workers, schools, and community leaders, and incentivization strategies can improve immunization coverage. A comprehensive, multi-sectoral approach is required to meet the village's immunization goals.

Management of the vaccination campaign in a population of frail older outpatients affected by cognitive or endocrinological conditions: a pilot study in Italy

Vaccination, particularly against pneumococcus and influenza, is a low-cost primary prevention, useful to avoid hard complications, particularly among frail older people. In this pilot study, we aimed to assess the effect of a strategy for influenza and pneumococcal vaccination for outpatients mainly affected by cognitive or endocrinological conditions, evaluating what could stimulate or demotivate vaccination among older people. This study was conducted during the 2023–2024 influenza season at the outpatient clinics in Palermo, Italy. A total 76 patients were included. More than half of the patients could be considered as pre-frail and about 20% frail, according to a comprehensive geriatric evaluation. Among patients, 46.05% received only vaccination against pneumococcus, 28.95% both vaccinations, and 25.0% only against influenza. Compared with the previous seasons, a 19.5% increase of influenza and 90.2% of pneumococcal vaccine uptake was observed. Side effects of vaccination were the main reason of the previous rejection, namely 76.9% for influenza and 53.8% for anti-pneumococcal vaccination. In conclusion, our study indicates how a new vaccination strategy in different settings could be feasible. Proposing influenza and pneumococcal vaccination for frail older outpatients could be an effective instrument to improve immunization coverage that is still low among older people.

Monitoring the VDPV2 outbreak in Egypt during 2020–2021 highlights the crucial role of environmental surveillance and boosting immunization in combating Poliovirus

BackgroundPoliovirus is a highly infectious enterovirus (EV) that primarily affects children and can lead to lifelong paralysis or even death. Vaccine-derived polioviruses (VDPVs) are a great threat since they are derived from the attenuated virus in the Oral Poliovirus Vaccine (OPV) and can mutate to a more virulent form. The purpose of this study was to identify VDPV serotype 2 through the year 2020–2021 via surveillance of sewage samples collected from different localities and governorates in Egypt and stool specimens from Acute Flaccid Paralysis (AFP) cases. Both were collected through the national poliovirus surveillance system and according to the guidelines recommended by the WHO.MethodsA total of 1266 sewage samples and 3241 stool samples from January 2020 to December 2021 were investigated in the lab according to World Health Organization (WHO) protocol for the presence of Polioviruses by cell culture, molecular identification of positive isolates on L20B cell line was carried out using real-time polymerase chain reactions (RT-PCR). Any positive isolates for Poliovirus type 2 and isolates suspected of Vaccine Derived Poliovirus Type 1 and type 3 screened by (VDPV1) or Vaccine Poliovirus Type 3 (VDPV3) assay in RT-PCR were referred for VP1 genetic sequencing.ResultsThe outbreak was caused by circulating VDPV2 (cVDPV2) strains started in January 2021. By the end of February 2021, a total of 11 cVDPV2s were detected in sewage samples from six governorates confirming the outbreak situation. One additional cVDPV2 was detected later in the sewage sample from Qena (June 2021). The first and only re-emergence of VDPV2 in stool samples during the outbreak was in contact with Luxor in June 2021. By November 2021, a total of 80 VDPVs were detected. The Egyptian Ministry of Health and Population (MOHP), in collaboration with the WHO, responded quickly by launching two massive vaccination campaigns targeting children under the age of five. Additionally, surveillance systems were strengthened to detect new cases and prevent further spread of the virus.ConclusionThe continued threat of poliovirus and VDPVs requires ongoing efforts to prevent their emergence and spread. Strategies such as improving immunization coverage, using genetically stable vaccines, and establishing surveillance systems are critical to achieving global eradication of poliovirus and efficient monitoring of VDPVs outbreaks.

Developing a roadmap to reach and sustain 90% full immunization coverage through a cross-sectoral system strengthening strategy in Bihar, India

IntroductionReducing childhood mortality by curtailing the incidence of vaccine preventable diseases is contingent upon a robust and high-performing routine immunization system. According to the available data, the full immunization coverage (FIC) in the state of Bihar (India) has reached ~ 71%. While the government aspires to reach 90% FIC, a systematic evidence-based investigation of the reasons behind underimmunization as well as the identification of drivers and enablers to reach and sustain 90% FIC is critical. This study aimed to review the factors leading to underimmunized children in the state of Bihar and develop a forward-looking roadmap to reach and sustain 90% FIC by adopting a system strengthening approach.MethodWe conducted a desk review, followed by extensive stakeholder interviews and field visits to document and analyze the data and evidence relevant to routine immunization system performance in the state of Bihar. The stakeholders included the State Immunization Officer, District Immunization Officers, Block-level health officials, representatives from development agencies, healthcare workers, and caregivers. A total of eighty-six structured interviews were conducted, which included qualitative and quantitative parameters.ResultWhile positive results were observed from the assessment of Bihar’s immunization system, the implementation of targeted strategies for supply, service delivery and demand can provide a means to achieve FIC of 90%. The roadmap developed by the Government of Bihar enlists 40 + interventions across key thematic areas and has been prioritized over a 5-year time horizon as short, medium, and long-term milestones to achieve 90% FIC. These interventions include strengthening the data availability and quality, improving the governance and review mechanism, augmenting the capacity of health workers involve with immunization programme, and initiatives to increase demand for immunization services.ConclusionThe Bihar’s Immunization Roadmap development project work follows a methodical approach to assess and identify intervention to improve immunization coverage and can provide information and reference to other states and countries that are aiming to formulate similar action plans.

Integrating Digital Health Solutions with Immunization Strategies: Improving Immunization Coverage and Monitoring in the Post-COVID-19 Era.

The COVID-19 pandemic underscored the critical importance of vaccination to global health security and highlighted the potential of digital health solutions to improve immunization strategies. This article explores integrating digital health technologies with immunization programs to improve coverage, monitoring, and public health outcomes. It examines the current landscape of digital tools used in immunization initiatives, such as mobile health apps, electronic health records, and data analytics platforms. Case studies from different regions demonstrate the effectiveness of these technologies in addressing challenges such as vaccine hesitancy, logistics, and real-time monitoring of vaccine distribution and adverse events. The paper also examines ethical considerations, data privacy issues, and the need for a robust digital infrastructure to support these innovations. By analyzing the successes and limitations of digital health interventions in immunization campaigns during and after the COVID-19 pandemic, we provide recommendations for future integration strategies to ensure resilient and responsive immunization systems. This research aims to guide policymakers, health professionals, and technologists in leveraging digital health to strengthen immunization efforts and prepare for future public health emergencies.

Measuring what matters: Context-specific indicators for assessing immunisation performance in Pacific Island Countries and Areas.

Increasing countries' access to data can improve immunisation coverage through evidence-based decision-making. However, data collection and reporting is resource-intensive, so needs to be pragmatic, especially in low-and-middle-income countries. We aimed to identify which indicators are most important for measuring, and improving, national immunisation performance in Pacific Island Countries (PICs). We conducted an expert elicitation study, asking 13 experts involved in delivering immunisation programs, decision-makers, health information specialists, and global development partners across PICs to rate 41 indicators based on their knowledge of the feasibility and relevance of each indicator. We also asked experts their preferences for indicators to be retained or removed from a list of indicators for PICs. Experts participated in two rating rounds, with a discussion on the reasons for ratings before the second round. We calculated mean scores for feasibility and relevance, and ranked indicators based on experts' preferences and mean scores. We used framework analysis to identify reasons for selecting indicators. Experts agreed that certain indicators were essential to measure (e.g. data use in program planning and measles vaccination coverage), but preferences varied for most indicators. Preferences to include indicators in a set of indicators for PICs moderately correlated with scores for relevance (r = 0.68) and feasibility (r = 0.56). In discussions, experts highlighted usefulness for decision-making and ease of data collection, reporting and interpretation as the main reasons driving indicator selection. Country-specific factors such as health system factors, roles and influence of various immunisation actors, and macro-level factors (namely population size, distribution and mobility) affected relevance and feasibility, leading us to conclude that a single set of indicators for all PICs is inappropriate. Rather than having a strict set of indicators that all countries must measure and report against, performance indicators should be flexible, country-specific, and selected in consultation with immunisation actors who collect and use the data.

Comprehensive Outreach: Reach Every Child Initiative Expanded Program on Immunization Khyber Pakhtunkhwa, Pakistan

Background: Vaccination is one of the most effective public health interventions for preventing infectious diseases. In regions like Khyber Pakhtunkhwa, Pakistan, where access to healthcare is limited, immunization coverage often remains below optimal levels. Targeted outreach activities can play a pivotal role in improving vaccine uptake, particularly in underserved populations. Objective: This study aimed to assess the effectiveness of immunization outreach activities in increasing vaccine coverage in Khyber Pakhtunkhwa over a defined period. Methods: A comprehensive methodological approach was utilized involving predefined Excel sheets for daily data collection by trained personnel. Data validation procedures were implemented to ensure accuracy, with regular feedback sessions to improve data collection processes. Monthly reports were compiled and analyzed using SPSS version 25 to summarize immunization activities and coverage rates. The outreach strategy included community announcements and door-to-door campaigns by Local Health Workers (LHWs), designed to identify and vaccinate zero-dose and defaulting children. Results: The outreach campaign significantly improved immunization coverage, with zero-dose vaccinations achieving 100% coverage. Penta I, II, and III vaccines saw coverage rates of 78.99%, 72.48%, and 78.02%, respectively. Measles vaccines MCV-I and MCV-II achieved coverage rates of 83.01% and 86.11%. The overall strategy effectively reduced gaps in vaccine coverage across various districts. Conclusion: The study confirms that structured and well-coordinated outreach activities can effectively increase immunization coverage in areas with limited healthcare access. Continuous effort and strategic planning are essential to sustain and build upon these gains to ensure comprehensive vaccine coverage.

IJCM_226A: Bridging the Gap: Model Immunization Centers in Urban Bihar - A Study on Factors Shaping Community Acceptance and Utilization for Improved Immunization Coverage

Background: Despite significant strides in immunization coverage, Full Immunization coverage in urban areas of India lags behind rural regions, with Urban India recording 75.5% compared to 76.8% in rural areas. Additionally, the prevalence of zero-dose children is higher in Urban India (7.5%) compared to rural counterparts (6.3%). Urbanization introduces a complex dynamic marked by poverty, migration, and growing disparities in health access, social services, and economic resources that necessitate innovative strategies to address immunization inequities in urban settings. In this direction, the Government of Bihar in 2017 introduced the concept of Model Immunization Centers (MICs) to provide high-quality immunization services to urban poor and marginalized to improve coverage and build trust, confidence and motivation for public immunization services. Objectives: The primary objective of the study was to assess and identify the factors that shape the community’s acceptance and utilization of immunization services at MICs in Patna and Siwan. Methodology: A mixed-methods approach was employed, combining quantitative data analysis of immunization records and demographic information with qualitative assessments of community perceptions through in-depth interviews and focus group discussions. The study site i.e., Patna and Siwan Districts of Bihar was purposively selected. Results: The study found that the effectiveness of MICs was significantly influenced by family, community, and social norms. Additionally, MICs played a pivotal role in enhancing people’s trust, confidence, and motivation through the provision of a favourable environment, hygiene maintenance, the availability of free vaccines, reduced waiting times, and courteous staff behaviour. These factors have collectively led to improved immunization coverage, increased footfall, and improved rates of full immunization. Conclusion: The success of MIC in gaining people’s trust and confidence has been a driving force behind the increase in footfall coverage at session sites and high Full Immunization Coverage in Patna and Siwan

Maintaining the Region of the Americas free of polio: best practices for incident management support teams.

The Pan American Health Organization (PAHO) and its Member States have been leading the efforts to eradicate wild poliovirus in the Region of Americas since smallpox's successful elimination in 1971. The region became the first to be certified free of wild poliovirus in 1994. However, in July 2022, an unvaccinated patient with no recent travel history was diagnosed with poliomyelitis in the United States of America. In response to the emergence of a circulating vaccine-derived poliovirus in the United States, PAHO established the Polio Incident Management Support Team. This team has been coordinating response efforts, focusing on: coordination, planning, and monitoring; risk communication and community engagement; surveillance and case investigation; vaccination; and rapid response. In this paper, we identified and documented best practices observed following establishment of the Incident Management Support Team (September 2022-2023) through a comprehensive review and analysis of various data sources and country-specific data from the polio surveillance dashboard. The aim was to share these best practices, highlighting technical support and implementation of polio measures by Member States. Despite several challenges, the Americas region remains polio-free. Polio risk is declining, with a July 2023 assessment showing fewer countries at medium, high, and very high risk. This progress reflects improved immunization coverage, surveillance, containment, health determinants, and outbreak preparedness and response. The PAHO Polio Incident Management Support Team has played a key role in supporting these efforts.

Evaluation of Knowledge, Attitudes, and Practices towards Vaccination among Patients with Spina Bifida in Ukraine

Patients with spina bifida (SB) face an increased risk of infection due to frequent exposure to medical procedures and visits to healthcare centers, including rehabilitation centers. Infection can lead to complications in kidneys and urinary bladder, disrupt rehabilitation efforts, and reduce the quality of life. Purpose - to assess the knowledge, attitudes, and practices related to vaccination among patients with SB and identify the reasons for the low vaccination rates in this group of children. Materials and methods. An anonymous online survey was conducted among 56 parents of patients with SB. The questionnaire evaluates the knowledge (10 questions), attitudes and practices (4 questions) towards vaccination among parents of patients with SB in Ukraine. The results were analyzed using standard procedures with Statistica StatSoft 6.0 software package. Continuous variables were expressed as a mean and standard deviation (SD). The comparison of frequency parameters was performed using the Chi-square test. The differences between the parameters were statistically significant at p<0.05. Results. Overall, parents demonstrated good knowledge about the role of vaccines in preventing serious diseases (61.7% gave correct answers), and the percentage of correct answers did not significantly differ between vaccinated, partially vaccinated, or unvaccinated groups of children. However, only 12.5% of SB patients were fully vaccinated and 51.8% were completely unvaccinated. Among the unvaccinated, the majority (55.2%) indicated non-recommendation by specialist doctors (neurosurgeon, neurologist, etc.) as the main reason. Primary care physicians were less likely to not recommend vaccination. Delayed vaccination was primarily due to fear of adverse reactions (40%). Despite low vaccination rates, parents generally had a positive attitude towards vaccination (only 5.4% against). Doctors remained the most influential source of information (63.4%). Conclusions. A study suggests a need to enhance knowledge among healthcare professionals, increase public awareness, and provide education within patient groups to improve immunization coverage and protect SB children from preventable infectious diseases. No conflict of interests was declared by the authors.

A Low-Cost, Integrated Immunization, Health, and Nutrition Intervention in Conflict Settings in Pakistan-The Impact on Zero-Dose Children and Polio Coverage.

Pakistan is one of two countries globally still endemic for poliovirus. While increasing immunization coverage is a concern, providing equitable access to care is also a priority, especially for conflict-affected populations. Recognizing these challenges, Naunehal, an integrated model of maternal, newborn, and child health (MNCH), immunization, and nutrition services delivered through community mobilization, mobile outreach, and private-sector engagement was implemented in conflict-affected union councils (UCs) with high poliovirus transmission, including Kharotabad 1(Quetta, Balochistan) and Bakhmal Ahmedzai (Lakki Marwat, Khyber Pakhtunkhwa). A quasi-experimental pre-post-design was used to assess the impact of the interventions implemented between April 2021 and April 2022, with a baseline and an endline survey. For each of the intervention UCs, a separate, matched-control UC was identified. At endline, the proportion of fully immunized children increased significantly from 27.5% to 51.0% in intervention UCs with a difference-in-difference (DiD) estimate of 13.6%. The proportion of zero-dose children and non-recipients of routine immunization (NR-RI) children decreased from 31.6% to 0.9% and from 31.9% to 3.4%, respectively, with a significant decrease in the latter group. Scaling up and assessing the adoption and feasibility of integrated interventions to improve immunization coverage can inform policymakers of the viability of such services in such contexts.

Factors Influencing Utilisation of Immunisation Services among Children Under Five Years in Lira Municipality Lira District Northern Uganda

This study investigated the factors influencing the utilization of immunization services among children under 5 years in Lira Municipality, Lira district, Northern Uganda. Utilizing a community-based cross-sectional design with quantitative data collection methods, 380 mother-infant pairs were randomly selected from residents of Lira Municipality. Univariate, bivariate, and multivariate logistic regression analyses were conducted using STATA software version 14.0 to identify significant factors affecting immunization service utilization. The study found that 77.63% (295/380) of children under 5 years utilized immunization services, with the highest utilization observed among male children (82.71%). Factors significantly influencing utilization included mothers' education level (aOR 7.46, 95%CI 2.17 – 25.65, P=0.001), religion (Muslims vs. Christians: aOR 0.15, 95%CI 0.07 – 0.32, P<0.001), rudeness of health workers (aOR 3.50, 95%CI 1.73 – 7.06, P<0.001), awareness of subsequent immunization schedules (aOR 0.38, 95%CI 0.20 – 0.70, P=0.002), possession of a child immunization card (aOR 0.34, 95%CI 0.19 – 0.63, P=0.001), and understaffing at health facilities (aOR 2.87, 95%CI 1.43 – 5.78, P=0.003). The study highlights the importance of addressing these factors to improve immunization coverage, which currently falls below the global target recommended by WHO and UNICEF. Keywords: Immunization services, Children, Under-Vaccinated, Unvaccinated, Mothers, No versus Yes.

Assessment of Parents' Knowledge, Attitudes, and Satisfaction of Childhood Immunization: A Cross-Sectional Survey from a Rural District of Sindh, Pakistan

Background: Immunization is a cornerstone of public health, preventing millions of deaths annually, especially among children. Despite global efforts to increase vaccination coverage, significant gaps remain, influenced by parental knowledge, attitudes, and satisfaction with immunization services. These gaps are particularly pronounced in rural and socio-economically disadvantaged regions. Objective: This study aimed to assess parents' knowledge, attitudes, and satisfaction regarding childhood immunization and to identify barriers to vaccination in a rural district of Sindh, Pakistan. Methods: A cross-sectional survey was conducted in two cities, Mirpurkhas and Digri, within the Mirpur Khas district. Using the Raosoft® Sample Size Calculator, a sample size of 382 participants was determined with a 95% confidence level and a 5% margin of error. Participants were selected through convenience sampling. Data collection involved a semi-structured questionnaire developed from extensive literature review and validated through expert focus group discussions. The questionnaire covered demographics, perceptions of immunization, knowledge of the Expanded Programme on Immunization (EPI) schedule, and satisfaction with immunization services. Data analysis employed SPSS version 25, utilizing descriptive statistics and Mann-Whitney tests to analyze differences between variables. Results: Among 382 respondents, 55.76% were male, and 44.24% were female. A significant proportion (43.45%) were aged between 21–30 years. The majority acknowledged the importance of immunization (96.85% agreement), yet knowledge gaps were evident, with only 10.98% correctly identifying vaccines given at birth. Satisfaction with immunization services was high (73.56% satisfied with hospital services), despite 88.46% reporting incorrect knowledge about the vaccine given at birth. Barriers identified included affordability, vaccine unavailability, and long waiting times. Conclusion: While parental attitudes towards immunization were largely positive, significant knowledge gaps and barriers to immunization persist. Efforts to improve immunization coverage in rural Pakistan must address these knowledge deficits and structural barriers, emphasizing the development of targeted awareness campaigns and enhancing the accessibility and quality of immunization services.