National Immunization Days Research Articles

Failure of poliomyelitis eradication campaign with oral vaccine: there's no vaccination without adherence

Thirty-five years after its launch, the Global Polio Eradication Initiative has yet to reach its original goal of 2000. Not only is the wild type 1 polio virus still endemic in two countries, but a new outbreak due to viruses derived from the live attenuated virus used for the oral vaccine has been spreading since 2016. The National Immunization Days (NID), during which teams go door-to-door and attract children to be vaccinated, have provoked violent opposition particularly in Northern Nigeria and in the area of India, Pakistan, Afghanistan. In both regions, the same rumor has developed that the vaccine contains sterilizing products, in order to limit the Muslim population. The organizers of the campaign multiplied in vain the NIDs to overcome the resistance, but pockets of insufficiently vaccinated population have persisted. This has allowed the wild virus to remain endemic and the new outbreak of vaccine-derived viruses to progress. We can wonder what the campaign would have become if its organizers had taken the time to reflect and reorient their strategy to rely on the routine vaccination of the Expanded Program on Immunization that does not arouse such opposition.

Factors Associated with Vaccine Refusal (Polio and Routine Immunization) in High-Risk Areas of Pakistan: A Matched Case-Control Study.

Pakistan has subpar childhood immunization rates and immunization activities have faced several challenges over the past years. We evaluated the social-behavioral and cultural barriers and risk factors for refusal of polio, Routine Immunization (RI), or both in high-risk areas of poliovirus circulation. A matched case-control study was conducted from April to July 2017 in eight super high-risk Union Councils of five towns in Karachi, Pakistan. A total of 3 groups, each with 250 cases, including refusals for the Oral Polio Vaccine (OPV) in campaigns (national immunization days and supplementary immunization activities), RI, and both, were matched with 500 controls and identified using surveillance records. Sociodemographic characteristics, household information, and immunization history were assessed. Study outcomes included social-behavioral and cultural barriers and reasons for vaccine refusal. Data were analyzed in STATA using conditional logistic regression. RI refusal was associated with illiteracy and fear of the vaccine's adverse effects, while OPV refusals were linked to the mother's decision authority and the assumption that the OPV caused infertility. Conversely, higher socioeconomic status (SES) and knowledge of and willingness to vaccinate with Inactivated Polio Vaccine (IPV) were inversely associated with RI; and lower SES, walking to the vaccination point, knowledge of IPV, and an understanding of contracting polio were inversely associated with OPV refusals, with the latter two also inversely associated with complete vaccine refusal. Education, knowledge and understanding of vaccines, and socioeconomic determinants influenced OPV and RI refusals among children. Effective interventions are needed to address knowledge gaps and misconceptions among parents.

Determining the Knowledge, Attitude and Practice of Mothers Regarding Neonatal Care at Department of Pediatrics Fatima Hospital, Baqai Medical University Karachi

Objective: The aim of this study was to assess the mother’s knowledge of neonatal care and their attitude towards existing preventive methods and practices. Materials and Methods: A hospital based Cross-Sectional descriptive Study was conducted on mothers who delivered recently in Fatima Hospital, Baqai Medical University and the mothers visiting with their neonate age of 28 days. Results: A total of 385 participants including the neonates of age 1 to 28 days were included in the study. We found statistically significant relationship between the mother’s age and the mother knowledge of neonatal care (P value = 0.002). Moreover, other factors that we found significantly conducive were the relationships between Illness and medication, mother’s age and breast feeding, mother’s education, and neonate vaccination (P value = 0.002). Conclusion: In this study, we observed that most of the mothers were unaware of neonatal care. Many of them were ignorant of the neonate vaccination and national immunization days. Most of them treated their sick neonates with traditional home remedies rather bringing them to the hospitals. A high proportion of mothers withheld breast feeding and top feeding during neonate illness. Their knowledge regarding infected umbilicus, neonate inactivity and lethargy was scarce. These findings indicate that there is a room of improvement in the current mother’s knowledge and practices of neonatal care. This study will facilitate the policy makers to design new care seeking practices that foster better knowledge of neonatal care among mothers. Keywords: Neonatal Care, immunization, breast feeding

Polio Eradication Efforts in India

With the global initiative of eradication of polio in 1988 following World Health Assembly resolution, pulse polio immunization program was launched in India in 1995 with goal to eradicate Polio from the world. This involves a high risk population that is children in the age group of 0-5 years, were administered polio drops on a single day through out the nation. India is working on four pillars of polio eradication: Routine immunization Supplementary immunization Surveillance Target mop-up campaign With continuous efforts, India has been removed from the list of polio-endemic countries. India continues to hold one NID and two Sub National Immunization Days for polio every year to maintain population immunity against wild poliovirus and to sustain its polio-free status.

How to estimate health service coverage in 58 districts of Benin with no survey data: Using hybrid estimation to fill the gaps.

The global movement to use routine information for managing health systems to achieve the Sustainable Development Goals, relies on administrative data which have inherent biases when used to estimate coverage with health services. Health policies and interventions planned with incorrect information can have detrimental impacts on communities. Statistical inferences using administrative data can be improved when they are combined with random probability survey data. Sometimes, survey data are only available for some districts. We present new methods for extending combined estimation techniques to all districts by combining additional data sources. Our study uses data from a probability survey (n = 1786) conducted during 2015 in 19 of Benin's 77 communes and administrative count data from all of them for a national immunization day (n = 2,792,803). Communes are equivalent to districts. We extend combined-data estimation from 19 to 77 communes by estimating denominators using the survey data and then building a statistical model using population estimates from different sources to estimate denominators in adjacent districts. By dividing administrative numerators by the model-estimated denominators we obtain extrapolated hybrid prevalence estimates. Framing the problem in the Bayesian paradigm guarantees estimated prevalence rates fall within the appropriate ranges and conveniently incorporates a sensitivity analysis. Our new methodology, estimated Benin's polio vaccination rates for 77 communes. We leveraged probability survey data from 19 communes to formulate estimates for the 58 communes with administrative data alone; polio vaccination coverage estimates in the 58 communes decreased to ranges consistent with those from the probability surveys (87%, standard deviation = 0.09) and more credible than the administrative estimates. Combining probability survey and administrative data can be extended beyond the districts in which both are collected to estimate coverage in an entire catchment area. These more accurate results will better inform health policy-making and intervention planning to reduce waste and improve health in communities.

Efforts Towards Polio Eradication in Madagascar: 1997 to 2017.

BackgroundIn 1988, the World Health Assembly launched the Global Polio Eradication Initiative. WHO AFRO is close to achieve this goal with the last wild poliovirus detected in 2014 in Borno States in Nigeria. The certification of the WHO African Region requires that all the 47 member states meet the critical indicators for a polio free status. Madagascar started implementing polio eradication activities in 1996 and was declared polio free in June 2018 in Abuja. This study describes the progress achieved towards polio eradication activities in Madagascar from 1977-2017 and highlights the remaining challenges to be addressed.MethodsData were collected from the national routine immunization services, Country Acute Flaccid surveillance databases and national reports of SIAS and Mop Up campaign. Country complete polio and immunization related documentation provided detailed historical information’s.ResultsFrom 1997 to 2017, Madagascar reported one wild poliovirus (WPV) outbreak and four circulating Vaccine Derived Polio Virus (cVDPV) oubreaks with a total of 21 polioviruses (1 WPV and 21 cVDPV). The last WPV and cVDPV were notified in 1997 in Antananarivo and 2015 in Sakaraha health districts respectively. Madagascar met the main polio surveillance indicators over the last ten years and made significant progress following the last cVDPV2 outbreak in 2014 -2015. In addition, the country successfully implemented the switch from trivalent Oral Polio Vaccine (tOPV) to bivalent Oral Polio vaccine (bOPV) and containment activities. Environmental Surveillance established since 2015 did not reveal any poliovirus. The administrative coverage of the 3rd dose of oral polio vaccine (OPV3) varied across the years from 55% in 1991 to a maximum of 95% in 2007 before a progressive decrease to 86% in 2017. The percentage of AFP cases with more than 3 doses of oral polio vaccines increased from 56% in 2014 to 88% in 2017. A total of 19 supplementary immunization activities (SIA) were conducted in Madagascar from 1997 to 2017, among which 3 were subnational immunization days (sNID) and 16 were national immunization days (NIDs). Poor routine coverage contributed to the occurrence of cVDPC outbreaks in the country; addressing this should remain a key priority for the country to maintain the polio free status.From 2015 to June 2017, Madagascar achieved the required criteria leading to the acceptance of the country’s polio-free documentation in June 2018 by ARCC. However, continuous efforts will be needed to maintain a highly sensitive polio surveillance system with emphasis on security compromised areas. Finally strengthening the health system and governance at all levels will be necessary if these achievements are to be sustained.ConclusionsHigh national political commitment and support of the Global Polio Eradication Partnership were critical for Madagascar to achieve polio free status. Socio-political instability, weakness of the health system, sub-optimal routine immunization performance, insufficient SIA quality and existing security compromised areas remain critical program challenges to address in order to maintaining the polio free status. Continuous high-level advocacy should be kept in order to ensure that new government authorities maintain polio eradication among the top priorities of the country.

Stepping Up Lady Health Worker (LHW) Program and Integrating the Electronic Immunization Record and Tracking System into the Program as a Pilot Project in the Underserved District of Quetta, Balochistan, Pakistan

Pakistan is one of those countries which are continuously struggling with providing essential primary healthcare services, especially in rural and underserved areas. To combat vaccine-preventable diseases, the Expanded Program on Immunization (EPI) has been active since 1978. Additionally, Lady Health Worker Program (LHWP) fits best with district health priorities of mother and child healthcare, family planning and National Immunization Days (NIDs). However, Pakistan faces many challenges. One is significant disparities in allocation and retention of LHW between provinces such as Punjab and Balochistan. Others are the lack of formal training and management of LHWs and a lack of immunization record system leading to vaccine wastage and broken logistics. How other low to middle-income countries (LMIC) are addressing these issues, is evident from Bangladesh and India. The Shasthya Shebika (SS) Program of Bangladesh is unique in having strategies for focused, structured training and retention of community health workers (CHWs) who receive small loans to establish funds, which they use to sell medical products to the community. To tackle the issue of lack of immunization data and vaccination wastage due to inadequate inventory, India has launched an Electronic Vaccination Intelligence Network (eVIN). The Ministry of Health, Pakistan has the potential to start a healthcare project to address the challenges mentioned above. The recommendations include allocation of 500 LHW (lady health workers) in the underserved district of Quetta in Balochistan with the implementation of retention strategies by funding LHW for small businesses, providing a formal educational structure and training and supervision of LHWs for innovative electronic immunization system. LHWs will have access to relevant educational materials and electronic devices such as tablets.

Business Continuity of Polio Eradication in the Context of COVID-19 Pandemic in Pakistan - A Success Story

Background: Pakistan is fighting with wild polio virus and Covid -19. Immunization gap could halt the achievements of Polio program and bridging the gap of immunity was only possible by supplemental immunization. This descriptive observational study on implementation of Supplementary Mass immunization Campaign with Oral Polio Vaccines during Covid -19 pandemic describes the process of strategic shift from conducting small scale target to full scale Pakistan National Immunization day. National Emergency Operational Cell (NEOC) Data was used for accessing the strategic shift & SIA indicator set by Global Polio Eradication Initiative.Methods: We analyzed the changes in process of SIA implementation and comprehended the strategic shift of campaign modalities, provision of personal protective equipment and measurement of the Covid-19 infection incidence amongst frontline health care workers. We analyzed the vaccine refusals numbers to rule out the fear of increase in refusal during Pandemic.Findings: Three SIA rounds were conducted with gradual increase from small-scale test campaign in six districts with children under five targets of seven hundred ninety thousand five hundred twenty-nine to a Sub National Immunization Days (SNIDs) August 2020 campaign conducted targeting thirty-four million under 5 children in one hundred thirty districts and National Immunization Days (NIDs) September 2020 country wide targeting forty million under 5 children in one-hundred sixty-three districts.Interpretation: National Emergency Action Plan(NEAP) of Pakistan has key program indicators. All three campaigns achieved target indicators. Number of vaccine refusal did not increase during Covid -19. Frontline vaccinators were provided with Sufficient number of Mask & Sanitizers and were trained on Standard operating procedures of WHO guideline for Polio SIA implementation. Infectivity with covid-19 did not increase in frontline workers.Funding Statement: No funding is taken for this research.Declaration of Interests: The authors whose names are listed as authors certify that they have No affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patentlicensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.Ethics Approval Statement: Approval was taken from National emergency operational cell, Polio eradication initiative Pakistan.

Managerial and Operational Hindrances to Polio Eradication: A Case Study of Tehsil Katlang, Mardan, Pakistan

The study aims to analyse managerial and operational hindrances to polio eradication process in Tehsil Katlang, District Mardan using quantitative research method i.e. questionnaire and statistical analysis. A sample size of 200 respondents i.e. polio workers of health department, staff of WHO and UNICEF are selected through proportionate stratified random technique. Bi-variate analyses are conducted with the help of Chi-square test. The study results concludes a significant association between polio eradication process and maintenance of cold chain, lack of transportation facility to polio staff, accessibility with reference to locality, training opportunities of polio workers, lack of trained public health professionals, workers dissatisfaction from salaries, timely payment of NIDs remuneration, unnecessary bureaucratic interventions and influences in Expended Program on Immunisation (EPI), lack of proper evaluation of National Immunisation Days (NIDs) campaign and security threats to polio workers. Further, a non-significant association is ascertained between polio eradication and timely availability of vaccines to EPI workers, effects of load shedding on maintenance of cold chain and proper monitoring of NIDs campaign. The findings state that the program needs proper management process for cold chain and transportation facilities. Salaries of the workers need to be increased and NIDs remuneration needs to pay on time. Various training programs should be initiated for workers and shortage of staff should be removed. Security arrangements for polio workers may be enhanced.

Assessment of risk factors associated with oral polio vaccine refusal in Rahim Yar Khan District, Pakistan (2017)

ObjectiveThis study aimed to determine the risk factors associated with oral polio vaccine (OPV) refusal. MethodologyA case-control study was conducted in Rahim Yar Khan (RYK) District, Pakistan. A case was defined as “any child aged <5 years who was enrolled in the microplans of RYK District as part of the National Immunization Days program in January 2017 and whose parents or guardians refused to receive OPV for these eligible children.” The age- and sex-matched controls (1:1) were obtained from the same locality. Ratios were calculated, and odds ratios (ORs) were determined at 95% confidence interval (CI) and p < 0.05. ResultsAmong the 110 children, 64 (58%) were male (male to female ratio, 1.4:1). The mean age was 29.5 months (range, 0.26–60 months). Seventy-four (67.2%) children were living in urban areas and 29 (26.3%) children were living in peri-urban and rural areas, while seven (6.3%) were considered nomads. A total of 72 (65.2%) children were Punjabi speaking, 33 (30%) were Saraiki speaking, 2 (3.7%) were Urdu speaking, and 2 (1.82%) were Balochi speaking. Repeated campaigns (n = 91, 82.7%) was the major reason for OPV refusal.Living at a distance >1 km from a healthcare facility was significantly associated (OR, 2.5; 95% CI, 1.4–4.4; p < 0.05) with OPV refusal, while prior visits by healthcare workers (OR, 0.11; 95% CI, 0.06–0.22; p < 0.05) and mother’ education above primary level (OR, 0.42; 95% CI, 0.24–0.73; p < 0.05) were inversely associated with OPV refusal. ConclusionOn the basis of our recommendations, door-to-door social mobilization visits by healthcare workers to alleviate fear, misconception, and fatigue of repeated campaigns and strict accountability mechanism were developed by district government at pre- and intra-campaign levels.

Polio Outbreak Response; Evaluation of Acute Flaccid Paralysis Surveillance in Karbala, Iraq.

Background:After the last outbreak of wild polio infection in Baghdad, April 2014, the Iraqi response to the outbreak was activated through solid surveillance of Acute Flaccid Paralysis (AFP) case detection in all governorates to interrupt the circulation of poliovirus in addition to the strengthening of Expanded Program on Immunization. This response to the last outbreak has to be evaluated independently to ensure effective mopping and surveillance to stop further outbreak all over the country including the holy province Karbala. We aimed to evaluate the response to the last polio outbreak by evaluating surveillance activities of acute flaccid paralysis cases whether they meet the recommended standards.Methods:Observational evaluation study conducted through August 15–25, 2015. Checking of Acute Flaccid Paralysis surveillance (AFP) activity through detection of nonPolio acute flaccid paralysis rate and immediate reporting with adequate stool sampling, and 60 days follow-up examination four districts of the province. The reviewing checked whether the surveillance system in Karbala met the global standards required for stopping wild poliovirus circulation. The evaluation included immunization coverage rates and active National Immunization days of oral polio vaccine campaigns.Results:During the period of review, the core surveillance indicators in Karbala met the globally set standards. Percent of acute flaccid paralysis cases with specimens reached to the reference laboratory within 3 days was 100%. Nonpolio cases was 4.2 per 100000 population under 15 years of age through week 33 of the year 2015. Eleven AFP cases were reported from all districts of Karbala among Population of children under 15 years of age. The percentage of cases with adequate specimens was 100% in 2015 versus 93% in 2014. The percent of AFP Cases notified within 7 days of paralysis onset (during first 33 weeks) was 100% in 2015 versus 87% in 2014.Conclusions:As Karbala response to polio outbreak met the target global indicators and standards of polio surveillance. The circulation of the virus in this locality was interrupted and further transmission of the disease is unlikely.

Prevalence and Determinants of Childhood Obesity in Dhaka City

Background: Obesity amongst the children is increasing worldwide at an alarming rate in both developed and developing countries. Obese children are at higher risk of developing coronary heart disease, non-insulin dependent diabetes, respiratory disease etc.&#x0D; Methods: A case-control study, preceded by a cross sectional survey was conducted, aimed to estimate the prevalence rate and to identify the factors associated with the development of childhood obesity in Dhaka city. A multi stage probability proportionate to size (PPS) cluster sampling method was used to obtain the sample. To identify the obese children, a pre-tested questionnaire was used to collect data on age, weight and height among the randomly selected 5000 children of 2-10 years age group from 12 government primary and 23 private elementary schools, 4 hospitals, 8 health centres and 12 immunisation centres (on National Immunisation Days) from all the 12 thanas (civil administrative sub-districts) of Dhaka city. Survey included a medical history and physical examination to assess the eligibility of the subjects for the study.&#x0D; Results: Of 5000 children, 380 (7.6%) were identified as obese using the criterion of weight for height &gt;120% as a cut-off point. Obesity was positively correlated with the increase of age in both sexes (r = 0.76). Of all obese children, 216 (56.8%) were boys and 164 (43.2%) were girls. Prevalence of obesity was significantly higher among the boys than girls (p=0.007). The study was conducted among the 220 cases of 380 obese children (Wt/Ht&gt; 120%) and 220 randomly selected controls, matching age and sex, using a semi-structured questionnaire for identifying the factors associated with the development of childhood obesity. Information also collected from parents of both cases and controls. Family income (p&lt;0.001) and expenditure on food (p&lt;0.001) were significantly higher among the cases. Data showed that parental obesity was significantly associated with the obesity in children. There was an association between obesity of the children and parents’ educational status (p&lt;0.001). There was no difference in the working hours of parents outside households between the cases and controls. Energy balance was significantly higher among the cases. Dose response of energy balance shows, the estimated relative risk of obesity increases with higher levels of energy balance up to a maximum of odds ratio 3.41 (p&lt;0.001). A significant difference (p&lt;0.001) was found in hours of television-video viewing between the cases and controls.&#x0D; Conclusion: Findings of this study show that the obesity among the children is caused by a positive energy balance over a considerable period, is related to environmental factors including energy intake, energy expenditure and other behavioural aspects. Appropriate interventions like behavioural change regarding energy intake and physical activity are thus recommended to address the childhood obesity- an emerging public health problem in Dhaka city.&#x0D; Bangladesh Med Res Counc Bull 2019; 45: 68-80

Estimation of coverage of pulse polio immunization round on 28th January 2018

Background: India accounted for more than 50% of polio cases globally. India therefore started the intensive pulse polio immunization (IPPI) in 1995. The national immunization days (NID) were on 28th January and 11th March 2018. The objectives of this study were to determine the completeness of pulse polio immunization round on 28th January 2018, to evaluate the reasons for non-compliance of the community towards the vaccination round, to assess the demographic profile amongst the unvaccinated children.Methods: A cross-sectional descriptive study was conducted among 570 children of zero-five years were checked in major areas of Pune that is Katraj Zoo, Swargate, Saras baug and a school in Dhankawadi. The data was collected after the first round of PPI by viewing the ink mark on the left little finger nail of the child or by interviewing the parents. SIA monitoring chart was used to assess the completeness of immunization campaign. Statistical analysis: Microsoft Excel were used to calculate percentages.Results: Out of 570, 69 (12.1%) were unvaccinated with the highest number seen in nursery that is 28 (40.6%). Amongst the unvaccinated (n=69), 40 (57.9%) were males. In the unvaccinated children (n=69), 13 (18.84%) and 56 (81.15%) belonged to age group of zero-two years and two-five years respectively. Reasons for being unvaccinated were 29(42%) parents were unaware of time and place of PPI, 21 (30.4%) were outside Pune and 19 (27.5%) were unwilling due to false beliefs..Conclusions: Awareness should be increased about benefits of PPI through mass media, local leaders and teachers to enhance community participation. The authorities’ in charge of the PPI should be informed regarding areas lacking significant coverage so that they can be concentrated upon during subsequent PPI rounds ultimately contributing to eradicate poliomyelitis.

Measles Vaccination Supports Millennium Development Goal 4: Increasing Coverage and Increasing Child Survival in Northern Ghana, 1996-2012.

Measles vaccine (MV) administered as the last vaccine after the third dose of diphtheria-tetanus-pertussis (DTP) may be associated with better child survival unrelated to prevention of measles infection. Other studies have shown that MV administered after DTP was more beneficial and was associated with lower mortality compared with DTP administered after MV or DTP administered simultaneously with MV. We compared the difference in mortality between measles vaccinated after DTP3 and measles-unvaccinated children in Navrongo, Ghana. This was a follow-up study involving annual cohort of children aged 9-23 months from 1996 to 2012. We assessed survival in relation to the measles vaccination status within the first 12 months from interview date and until 5 years of age using Cox proportional hazards models. In all, 38,333 children were included in the study. The proportion of children vaccinated with MV-after-DTP3 increased from 45% in 1996 to 95% in 2012. The adjusted hazard ratio (HR) for measles unvaccinated compared with MV-after-DTP3 vaccinated children was 1.38 (1.15-1.66) in the first 12 months after assessment of vaccination status and 1.22 (1.05-1.41) with follow-up to 5 years of age. The national immunization days campaigns with oral polio vaccine or MV might have reduced the effect of being MV-after-DTP3 vaccinated vs MV-unvaccinated. For 12 months of follow-up, the HR before a campaign for MV-unvaccinated children was 1.63 (1.23-2.17) compared to those who received MV-after-DTP3. After the campaign, the HR reduced to 1.23 (0.97-1.54). Stratifying the analysis by sex, measles-unvaccinated boys had a HR of 1.69 (1.33-2.61) compared to measles-unvaccinated girls who had a HR 1.06 (0.79-1.40) during 1-year follow-up. In 1989, only 7% of children in the area had received MV-after-DTP3; the increase in MV-after-DTP3 coverage from 1989 to 2012 may have lowered mortality rate among children aged 9 months to 3 years by 24%. Though an observational study, our findings suggest that measles vaccination, administered in the recommended sequence, is associated with improved child survival and may have contributed importantly to the mortality decline toward the achievement of Millennium Development Goal 4.

Vaccine-related poliovirus shedding in trivalent polio vaccine and human immunodeficiency virus status: analysis from under five children

BackgroundPoliomyelitis is an acute viral infection caused by poliovirus and transmitted via the fecal–oral route. The causative agent is one of the three serotypes of poliovirus (serotypes 1, 2, 3) that differ slightly in capsid protein. Prolonged vaccine-related poliovirus shedding in human immunodeficiency virus (HIV) positive individuals has been linked to possible reservoir for reintroduction of polioviruses after eradication. The study therefore aimed at estimating the duration for vaccine-related poliovirus shedding among potentially and HIV-infected persons.MethodsPoliovirus excretion was studied following vaccination of children aged ≤ 59 month per human immunodeficiency virus status after national immunization days. Their medical records were reviewed to identify the child’s HIV status, demographic and immunization data. Sequential stool samples were collected at site 2nd, 4th and 8th week after trivalent oral poliovirus vaccine (tOPV) was administered. To isolate suspected polioviruses and non-polio enteroviruses, characterize poliovirus subtypes by intratypic differentiation and Sabin vaccine derived poliovirus, real time polymerase chain reaction was applied. Shedding for ≥ 24 weeks was defined as long-term persistence.ResultsThe mean age of the study population was 28.6 months, while the median age was 24 months. Of the children recruited, majority were in the 25–48 months (n = 12; 46.2%) age category. All the HIV-positive children (n = 10) had mild symptomatic HIV status and did shed vaccine-related polioviruses between weeks 2 and 4 respectively. No participant shed polioviruses for ≥ 6 weeks.ConclusionsIt was evident mildly symptomatic HIV+ children sustain the capacity to clear vaccine-related poliovirus. The oral poliovirus vaccine-2 (Sabin like) that was detected in one HIV-infected child’s stool 6 weeks after the national immunization days was predominantly non revertant. There was no evident prolonged poliovirus shedding among the participants enlisted in the present study. High powered studies are desired to further corroborate these findings.

Rotary's PolioPlus Program: Lessons Learned, Transition Planning, and Legacy.

Hundreds of thousands of Rotary volunteers have provided support for polio eradication activities and continue to this day by making financial contributions to the Rotary PolioPlus program, participating in national immunization days, assisting with surveillance, working on local, national, and international advocacy programs for polio eradication, assisting at immunization posts and clinics, and mobilizing their communities for immunization activities (including poliovirus and other vaccines) and other health benefits. Rotary has contributed more than $1.61 billion for the global eradication of polio and has committed to provide an additional $35 million each year until 2018 (all dollar amounts represent US dollars). Its unwavering commitment to eradicate polio has been vital to the success of the program. Rotary is providing additional support for routine immunization and healthcare. When polio is finally gone, we will have the knowledge from the lessons learned with PolioPlus, such as the value of direct involvement by local Rotarians, the program for emergency funding, innovative tactics, and additional approaches for tackling other global issues, even those beyond public health. Rotary has already transitioned its grants program to include 6 areas of focus: disease prevention and treatment, water and sanitation, maternal and child health, basic education and literacy, economic and community development, and peace and conflict prevention/resolution. Funding for these grants in 2015–2016 was $71 million. The legacy of the polio program will be the complete eradication of poliovirus and the elimination of polio for all time.

POLIO VACCINE;

Objectives: To assess knowledge and attitude of young doctors serving in Tertiarycare Hospitals regarding the IPV intervention and polio eradication campaign. Study Design:A cross sectional descriptive study. Setting: Five Tertiary Care Hospitals in Rawalpindi andIslamabad. Period: Oct 2015-Nov 2015. Methods: Proportionate random sampling techniquewas used to select a sample of 100 doctors working in pediatrics wards and out patientsdepartments (OPD). After taking informed consent the data was collected using a standardizedQuestionnaire to measure level of awareness among this cohort of Health care providers. Datawere entered and analyzed using SPSS version 21. Baseline distinctiveness (demographic)was summarized by descriptive statistics. The statistical inference was drawn using Chi squaretest, p value of ≤ 0.05 was considered as significant. Results The study sample comprised of47 males and 53 females. Mean age of participants was 29.8 ± 5.7. There were 15% HouseOfficers, 45% Post Graduate Trainees, 30% Medical Officers and 10% consultants in thesample. Majority of doctors (65%) expressed disinterest and doubt about polio immunizationwhile 40% suggested focus on sanitation and health promotion before immunization. Amongthe participants only 29% had attended polio surveillance training workshop in last 2 years andparticipated in polio National Immunization days. There was no significant association betweenknowledge about IPV and years of experience(x2 =2.68, p= 0.433). Conclusion: This studysuggests that there was inadequate knowledge of doctors in tertiary care hospitals regardingIPV and polio eradication efforts in Pakistan.

English

Objectives: To assess knowledge and attitude of young doctors serving in Tertiarycare Hospitals regarding the IPV intervention and polio eradication campaign. Study Design:A cross sectional descriptive study. Setting: Five Tertiary Care Hospitals in Rawalpindi andIslamabad. Period: Oct 2015-Nov 2015. Methods: Proportionate random sampling techniquewas used to select a sample of 100 doctors working in pediatrics wards and out patientsdepartments (OPD). After taking informed consent the data was collected using a standardizedQuestionnaire to measure level of awareness among this cohort of Health care providers. Datawere entered and analyzed using SPSS version 21. Baseline distinctiveness (demographic)was summarized by descriptive statistics. The statistical inference was drawn using Chi squaretest, p value of ≤ 0.05 was considered as significant. Results The study sample comprised of47 males and 53 females. Mean age of participants was 29.8 ± 5.7. There were 15% HouseOfficers, 45% Post Graduate Trainees, 30% Medical Officers and 10% consultants in thesample. Majority of doctors (65%) expressed disinterest and doubt about polio immunizationwhile 40% suggested focus on sanitation and health promotion before immunization. Amongthe participants only 29% had attended polio surveillance training workshop in last 2 years andparticipated in polio National Immunization days. There was no significant association betweenknowledge about IPV and years of experience(x2 =2.68, p= 0.433). Conclusion: This studysuggests that there was inadequate knowledge of doctors in tertiary care hospitals regardingIPV and polio eradication efforts in Pakistan.

A case-control study on the association of pulse oral poliomyelitis vaccination and Gianotti-Crosti syndrome.

Since 1995, the Indian government has been launching two National Immunization Days (NIDs) annually to administer oral polio vaccines (OPVs) to children under the age of 5. Our aim was to investigate the association between OPVs and Gianotti-Crosti syndrome (GCS). A board-certified dermatologist in solo practice conducted the examinations. The patients consulted without the need of a referral. We retrieved files of all children under the age of 5 who were diagnosed with GCS in 18months. There were three NIDs during these months. We charted the number of children 1month before, 1week before, 1week after, and 1month after the three NIDs. A total of 116 children (49 boys and 67 girls) under the age of 5 with GCS were found (average age: 2.9years) within these 18months of three NIDs. Eleven (9.5%) and 105 (90.5%) children developed GCS 1month before and 1month following OPV administration, respectively (RR: 1.81; 95% CI: 1.40-2.35; P<0.0001). Three (2.6%) and 58 (50.0%) children developed GCS 1week before and 1week after OPV administration, respectively (RR: 1.90; 95% CI: 1.12-3.22; P<0.0001). The administration of OPV is significantly associated with the occurrence of GCS in the part of the world that we investigated. As we demonstrated a temporal relationship, this association is likely to be causal.

Determinants of Childhood Immunization Coverage Among Children Aged 12-23 Months in Mara Division, Narok West Sub County, Narok County, Kenya

Immunization has been shown to be one of the most cost effective health interventions worldwide, through which a number of serious childhood diseases have been successfully prevented or eradicated. WHO scaled it from 10% in 1974 to 80% in 1990 against smallpox. The study was to establish the factors that determine immunization coverage among children between the ages of 12-23 months in Mara Division, Narok West Sub-County. In seeking to determine the coverage, the study looked at both Demographic and Socio-Economic Factors associated with immunization coverage in the area. This was a cross-sectional survey study of children aged between 12-23 months among randomized health facilities within the study area of Mara Division, in Narok County. Information on Demographic and Socio-Economic Factors and immunization status of children aged 12-23 years of age was obtained from mothers and caretakers. A sample size of 421 respondents was involved in the target facilities with a response rate of 95%. The findings show a strong association between education and immunization. Mothers’ employment and occupations has shown a likelihood to seek immunization for their children. The study noted the significance of the place of child delivery with those born in health facilities with likelihoods of routine immunization. The study has equally shown that immunization uptake in the area has improved compared to previous reports showing a coverage of 65.9%. Out of these findings; the study concludes that, the Ministry of Health need to improve on supplemental immunization activities such as National Immunization Days (NIDs) and Catch-up campaigns that are already in place. These should be planned and regularly carried out based on how to improve routine immunization coverage and control out-breaks situations like Measles and Polio. In addition, the both the National and County Government should work with religious institutions and leaders especially in the Mara division, Narok West Sub-County so as to improve the uptake of vaccine. Educational programmes that can target poor and uneducated people should be put in place so that they are able to make informed decisions regarding immunization of their children.