National Immunization Days Research Articles

Validation of Administrative Coverage for Vitamin a Supplementation and Deworming through Integrated National Immunization Days in Guinea

Validation of Administrative Coverage for Vitamin a Supplementation and Deworming through Integrated National Immunization Days in Guinea

Polio inactivated vaccine costs into routine childhood immunization in Brazil.

OBJECTIVE To analyze the costs of vaccination regimens for introducing inactivated polio vaccine in routine immunization in Brazil.METHODS A cost analysis was conducted for vaccines in five vaccination regimens, including inactivated polio vaccine, compared with the oral polio vaccine-only regimen. The costs of the vaccines were estimated for routine use and for the “National Immunization Days”, during when the oral polio vaccine is administered to children aged less than five years, independent of their vaccine status, and the strategic stock of inactivated polio vaccine. The presented estimated costs are of 2011.RESULTS The annual costs of the oral vaccine-only program (routine and two National Immunization Days) were estimated at US$19,873,170. The incremental costs of inclusion of the inactivated vaccine depended on the number of vaccine doses, presentation of the vaccine (bottles with single dose or ten doses), and number of “National Immunization Days” carried out. The cost of the regimen adopted with two doses of inactivated vaccine followed by three doses of oral vaccine and one “National Immunization Day” was estimated at US$29,653,539. The concomitant replacement of the DTPw/Hib and HepB vaccines with the pentavalent vaccine enabled the introduction of the inactivated polio without increasing the number of injections or number of visits needed to complete the vaccination.CONCLUSIONS The introduction of the inactivated vaccine increased the annual costs of the polio vaccines by 49.2% compared with the oral vaccine-only regimen. This increase represented 1.13% of the expenditure of the National Immunization Program on the purchase of vaccines in 2011.

Review of the Oral Polio Vaccineimmunization Coverage with Regard to Polio Eradication in Zambia: 2000-2009

Objectives: To review the Oral Polio Vaccine (OPV) immunization coverage (routine and supplemental) in Zambia from 2000 to 2009, with the view of identifying opportunities for system strengthening, given that routine immunization is the “bed rock” for polio eradication. Design: A retrospective descriptive analysis design was conducted on secondary routine and supplemental immunization data for Zambia for the period 2000-2009, consisting of all children aged<5years who had received OPV country wide. Immunization performance was evaluated using the WHO-specified 90% target Results: The target of 90% for Routine Immunization (RI)could not be reached in most provinces. Only Central province attained the target throughout the stated period. In 2004 and 2008, all provinces apart from Copperbelt attained the target. The 90%target for supplemental immunization activities were reached during all rounds of National Immunization Days (NIDs) apart from the first two (2) rounds in1996. The two rounds of Mopping –up immunization in 2002 attained the90% target Conclusion: Routine immunization for the oral polio vaccine has been an integral part of immunization activities in Zambia. The WHO target for OPV immunization was not attained in most districts and provinces in the period under review. This situation needs to be addressed through partner collaboration to raise herd immunity in case of imported polio viruses. While RI alone cannot eradicate the disease, good routine OPV coverage reduces the incidence of polio and makes eradication feasible. It also prevents the re-establishment of poliovirus if it is re-introduced from other countries, through international travelers and migrant populations from conflict areas

Failure of Polio Eradication in Pakistan.

Pakistan is one of the three countries where poliomyelitis is still considered as an endemic viral infection', Inevery round of National Immunization day (NIDs) over30 million children are immunized for polio by ExpandedProgram on Immunization with the support of multiplemultinational donors and private sector. ii In every campaign over 6000 permanent centers and more than onemillion outreach and mobile vaccination sessions provides immunization services with the support of morethan 10,000 vaccinators and approximately 6000 ladyhealth visitors (LHVs)iii. Despite the utilization of hugeamount of resources Pakistan fail to eradicate the polioresulted international communities imposed a travel banon Pakistan in 2013.iv Literature review suggested multiple reason for failure in eradication of polio, some arediscussed below.

Introduction of sequential inactivated polio vaccine-oral polio vaccine schedule for routine infant immunization in Brazil's National Immunization Program.

In August 2012, the Brazilian Ministry of Health introduced inactivated polio vaccine (IPV) as part of sequential polio vaccination schedule for all infants beginning their primary vaccination series. The revised childhood immunization schedule included 2 doses of IPV at 2 and 4 months of age followed by 2 doses of oral polio vaccine (OPV) at 6 and 15 months of age. One annual national polio immunization day was maintained to provide OPV to all children aged 6 to 59 months. The decision to introduce IPV was based on preventing rare cases of vaccine-associated paralytic polio, financially sustaining IPV introduction, ensuring equitable access to IPV, and preparing for future OPV cessation following global eradication. Introducing IPV during a national multivaccination campaign led to rapid uptake, despite challenges with local vaccine supply due to high wastage rates. Continuous monitoring is required to achieve high coverage with the sequential polio vaccine schedule.

From regional pulse vaccination to global disease eradication: insights from a mathematical model of poliomyelitis.

Mass-vaccination campaigns are an important strategy in the global fight against poliomyelitis and measles. The large-scale logistics required for these mass immunisation campaigns magnifies the need for research into the effectiveness and optimal deployment of pulse vaccination. In order to better understand this control strategy, we propose a mathematical model accounting for the disease dynamics in connected regions, incorporating seasonality, environmental reservoirs and independent periodic pulse vaccination schedules in each region. The effective reproduction number, Re, is defined and proved to be a global threshold for persistence of the disease. Analytical and numerical calculations show the importance of synchronising the pulse vaccinations in connected regions and the timing of the pulses with respect to the pathogen circulation seasonality. Our results indicate that it may be crucial for mass-vaccination programs, such as national immunisation days, to be synchronised across different regions. In addition, simulations show that a migration imbalance can increase Re and alter how pulse vaccination should be optimally distributed among the patches, similar to results found with constant-rate vaccination. Furthermore, contrary to the case of constant-rate vaccination, the fraction of environmental transmission affects the value of Re when pulse vaccination is present.

STUDY OF IMMUNITY TO POLIOVIRUSES ON CERTAIN "SILENT" TERRITORIES OF RUSSIA

Abstract. The degree of immunity to polioviruses of three serotypes among children of different ages was analysed on certain "controlled" and "silent" territories of Russia in different periods of Polio Eradication Initiative. It was shown that the levels of immunity of children’s population to polioviruses on "controlled" and "silent" territories had no significant difference. It was stated that on the phase which preceded the certification for the absence of circulation of wild polioviruses, when the National Immunisation Days were conducted in the country, the percentage of eronegative children to polioviruses of different serotypes was low on all the territories of Russia. After Russia as a part of the WHO European region was certified as a polio free country and mass immunisation was stopped thepercentage of seronegative children increased, especially to poliovirus of serotype 3, both on the "controlled" and on the "silent" territories.

A strategy for scaling up vitamin A supplementation for young children in a remote rural setting in Zimbabwe

Background. Vitamin A deficiency is a public health problem in Zimbabwe. Addressing vitamin A deficiency has the potential to enhance resistance to disease and reduce mortality especially in children aged <5 years. Objective. To describe a vitamin A supplementation outreach strategy implemented in one of the remote rural districts in Zimbabwe, which increased coverage after being implemented in difficult circumstances in a remote rural region. Methods. We implemented and adapted a vitamin A supplementation outreach strategy within the national immunisation days (NIDs) and extended programme of immunisation in a remote rural district in Zimbabwe. The strategy involved supplementating children at prescheduled outreach points once per month for the whole year. Despite usual operational challenges faced at implementation, this approach enabled the district to increase delivery of vitamin A supplements to young children in the district. Results. The strategy covered 63 outreach sites, with two sites being covered per day and visited once per month for the whole year. Coverage reached 71% in an area in which previous coverage rates were around <50%. Conclusion. Implementing a vitamin A supplementation outreach strategy increased vitamin A supplementation coverage among children living in a remote rural region. This strategy can potentially be used by Scaling Up Nutrition (SUN) member states. However, we recommend further exploration of this strategy by others working in similar circumstances.

Assessment of cold-chain maintenance in vaccine carriers during Pulse Polio National Immunization Day in a rural block of India.

India was certified polio free on 27 March 2014. Supplementary immunization activities, in the form of national immunization days, is one of the core strategies for eradication, where oral polio vaccine is administered to children aged under 5 years throughout the country. Oral polio vaccine is heat sensitive and requires maintenance of a stringent cold chain. Therefore, vaccine carriers with ice packs are used in the Pulse Polio Immunization (PPI) programme. This study assessed whether the cold chain is maintained during National Immunization Day in Beed district. A cross-sectional study was conducted at six randomly selected booths, one each from six primary health centres in Georai block of Beed district in Maharashtra. Electronic data loggers, configured to measure half-hourly temperatures, were kept in vaccine carriers throughout the day of PPI. The vaccine carrier temperature was below 8 °C at all six booths; minimum temperature recorded was -9.5 °C, while the maximum was 4.5 °C. The vaccine vial monitor did not reach discard point in any booth. A vaccine carrier with four ice packs very effectively maintains the cold chain required for oral polio vaccine.

Wild Poliovirus Importation, Central African Republic1

Wild Poliovirus Importation, Central African Republic1

Motivations and Challenges of Community-Based Surveillance Volunteers in the Northern Region of Ghana

Community health workers (CHWs) are an important element of many health systems and programmes for the promotion and delivery of a wide range of health interventions and disease surveillance. Understanding the motivation and retention of CHWs is recognized as essential but there are few data from sub-Saharan Africa. This qualitative study explored factors that motivate, and the challenges faced by community-based surveillance volunteers (CBSVs) in the Northern Region of Ghana through semi-structured interviews with 28 CBSVs, 12 zonal coordinators, nine Ghana Health Service (GHS) sub-district level staff, ten GHS district level staff and two GHS regional level staff in the administrative capital. The community emerged as an important motivating factor in terms of altruism, a sense of duty to the community and gaining community respect and pride. This was enhanced by community selection of the volunteers. Major challenges included incorrect community perceptions of CBSVs, problems with transportation and equipment, difficulties conducting both volunteer and farm work and late or lack of payment for ad hoc tasks such as National Immunization Days. Most CBSVs recognized that they were volunteers, understood the constraints of the health system and were not demanding remuneration. However, CBSVs strongly desired something tangible to show that their work is recognized and appreciated and described a number of low cost items that could be used. They also desired equipment such as raincoats and identifiers such as tee-shirts and certificates.

Use of a Novel Real-Time PCR Assay To Detect Oral Polio Vaccine Shedding and Reversion in Stool and Sewage Samples after a Mexican National Immunization Day

During replication, oral polio vaccine (OPV) can revert to neurovirulence and cause paralytic poliomyelitis. In individual vaccinees, it can acquire specific revertant point mutations, leading to vaccine-associated paralytic poliomyelitis (VAPP). With longer replication, OPV can mutate into vaccine-derived poliovirus (VDPV), which causes poliomyelitis outbreaks similar to those caused by wild poliovirus. After wild poliovirus eradication, safely phasing out vaccination will likely require global use of inactivated polio vaccine (IPV) until cessation of OPV circulation. Mexico, where children receive routine IPV but where OPV is given biannually during national immunization days (NIDs), provides a natural setting to study the duration of OPV circulation in a population primarily vaccinated with IPV. We developed a real-time PCR assay to detect and distinguish revertant and nonrevertant OPV serotype 1 (OPV-1), OPV-2, and OPV-3 from RNA extracted directly from stool and sewage. Stool samples from 124 children and 8 1-liter sewage samples from Orizaba, Veracruz, Mexico, collected 6 to 13 weeks after a NID were analyzed. Revertant OPV-1 was found in stool at 7 and 9 weeks, and nonrevertant OPV-2 and OPV-3 were found in stool from two children 10 weeks after the NID. Revertant OPV-1 and nonrevertant OPV-2 and -3 were detected in sewage at 6 and 13 weeks after the NID. Our real-time PCR assay was able to detect small amounts of OPV in both stool and sewage and to distinguish nonrevertant and revertant serotypes and demonstrated that OPV continues to circulate at least 13 weeks after a NID in a Mexican population routinely immunized with IPV.

Evaluation of immunity against poliovirus serotypes among children in riverine areas of Delta State, Nigeria

Nigeria remains one of the major reservoirs for wild poliovirus transmission despite the reported success in National Immunization Days and acute flaccid paralysis surveillance. Two hundred children aged &le; 10 years, were enrolled following parental consent from hard-to-reach riverine areas of Delta state of Nigeria to assess the level of protective immunity to poliovirus. Neutralizing antibodies to the three poliovirus serotypes in the serum samples of the children were determined by the beta method of neutralization.Eight (4%) of the children had no detectable antibody, 178 (89%), 180 (90%) and 181 (90.5%) were positive for antibodies to poliovirus types 1, 2 and 3, respectively. Overall, 162 (81%) of the children had antibodies to the three poliovirus serotypes at a titre of at least 1:8. The study shows the need for proper monitoring of vaccination coverage in such hard-to-reach riverine areas to achieve the objective of the global eradication of poliovirus.Keywords: Neutralizing, antibody, poliovirus, serotypes, riverine, Nigeria

Floods in Pakistan: a public health crisis

Background In August 2010, Pakistan experienced floods that affected 20 million people in 78 districts, killed 1800, damaged or destroyed about 2 million homes, 514 health facilities and inundated a land mass the size of England. (1) Prior to this current crisis, Pakistan already had about four million internally displaced people and refugees due to the war along the Afghan border and the 2005 earthquake in Khyber-Pakhtunkhwa (formerly North-West Frontier Province). Health indicators in Pakistan were dismal even before the floods, with maternal mortality at 230 (190-280) per 100 000 live births and under-5 mortality at 89 per 1000 live births. (2) Most of the flooded populations comprise the lowest socioeconomic quintiles that were already facing neglect. This crisis has worsened their plight. Relief agencies Relief operations were mainly carried out by the Pakistani government, the army and international agencies such as the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), Medecins Sans Frontieres and the United States Agency for International Development (USAID). (3) In addition, civilian volunteers, independent teams of physicians, nongovernmental organizations and various other groups with little experience in disaster relief were also working in the field. The Pakistan army provided the most visible rescue operations but was overextended with massive rescue efforts, shoring up and breaching dykes, as well as fighting the war in the tribal areas. The National Disaster Management Authority was established after the earthquake in 2005. However, it does not have a dedicated post for an individual overseeing the public health aspect of the disaster. Widespread mistrust of governmental agencies, primarily stemming from perceived corruption and mismanagement, has hindered donors and citizens from cooperating with governmental initiatives. We strongly recommend that the government take the lead in coordinating the public health response and allocate personnel and resources to that effect. Infectious diseases Between August and September 2010, 6.2 million consultations for gastroenteritis, respiratory infections, malaria and dermatologic conditions were reported to WHO from 50 of 64 affected districts, with countless more predicted to fall sick in the period that followed. (1) Using surveillance data from flood-affected districts, WHO reported mounting cases of Crimean-Congo haemorrhagic fever, dengue fever, cholera, falciparum malaria, measles and polio. (3) A nationwide diphtheria outbreak was also unfolding at the time of writing this paper. An oral cholera vaccine is available and recommended for use in humanitarian emergencies by WHO (4) yet it has not been recommended for use in flood-affected areas due to perceived logistic difficulties in delivery, e.g. two-dose regimen, vaccine production capacity. While such obstacles were overcome for delivery of the H1N1 pandemic flu vaccine, mass cholera vaccination was not given priority in Pakistan. With the manufacture and potential availability of a cheap and effective cholera vaccine from India, mass vaccination may have been a consideration for the affected populations in Pakistan. Adverse impact on polio eradication has been significant. Pakistan is one of only four countries where polio remains endemic. Eradication remains a challenge due to the complex situation exacerbated by the war in Afghanistan, insurgency in Pakistan and the resulting mass movement of people. By 9 November 2010, Pakistan accounted for about 62% (111 cases) of all 180 polio cases from endemic countries, (5) and most new cases were from flood-affected areas. (3) However, WHO increased efforts at delivering vaccination services in 45 flood-affected districts and, due to enhanced cooperation between the Pakistan Expanded Program on Immunization (EPI), WHO and UNICEF, national immunization days went ahead as planned. …

Mothers’ knowledge, Perceptions and practices of Home based management of Childhood Diarrhea in aRural Community in Anambra State, Nigeria

Objective: This study was designed to examine mothers' knowledge, perceptions and practices of household case management of childhood diarrhea. Subjects and methods: Two hundred and four (204) mothers were selected by a multistage, clustered, systematic sampling technique during the four day house-to-house national immunization day (NID) campaign in Neni Community on March, 2006. Information was collected with a pretested interviewer administered questionnaire, and data entry and analysis were done using the EPI INFO 3.2.2 version software. Results: The mean age and parity of the mothers were 27+ 5 years and 2.7+1.8, respectively. They were mainly housewives (38.2%) and traders (33.3%). More than two third (73.0%) had secondary education. Many of the mothers lacked accurate knowledge about the specific causes of childhood diarrhea, as they associated it with divergent causes. Almost all the respondents (99.0%) were aware of oral rehydration solution/salt sugar solution (ORS/SSS); and 87.7% agreed that ORS/SSS is effective for the treatment of diarrhea, but only 44.3% gave ORS/SSS, while 29.4% gave antibiotics/antidiarhea drugs to their children who suffered diarrhea. Only 40.9% knew how to prepare ORS/SSS correctly, and the correct knowledge of ORS/SSS preparation was significantly associated with the source of information. (x2 = 25.82, df = 4, P = 0.000). The health facilities served as the major sources of information (74.0%). Others sources were friends /relations/neighbours (22.6%) and media (3.4%). About 82.8% indicated that antibiotic/antidiarrhea drugs should be administered to a child with diarrhea. Conclusion: The findings underscore the need for more effective health education sessions for mothers on the proper management of diarrhea at home. Key words: Mothers' knowledge, perception, home management, childhood diarrhea, rural Nigeria.

Mass measles rubella immunization campaign: bhutan experience.

Background:Bhutan has attained universal child immunization since 1991. Since then, immunization coverage is maintained at high level through routine immunization, periodic National Immunization Days, and mop up campaigns. Despite high immunization coverage, every year, significant numbers of clinically suspected measles cases were reported.Objective:To assess the cause of continuing high “suspected measles cases” and take appropriate public health measures.Materials and Methods:Febrile rash outbreaks occurred in several districts in 2003. These episodes were investigated. Simultaneously, a retrospective data search revealed evidence of congenital rubella syndrome (CRS) in the country.Results:Thirty five percent of the tested samples were positive for rubella but none for measles. There were evidences of the presence of CRS. This was discussed in the annual health conference 2004, amongst health policy makers and district heads who recommended that a possibility of inclusion of rubella as an antigen be looked into. A nationwide measles and rubella immunization campaign was conducted in 2006 followed by introduction of rubella vaccine in the immunization schedule.Conclusion:Febrile rash can be caused by a host of viral infections. Following universal measles immunization, it is pertinent that febrile rash be looked in the light of rubella infections. Following the introduction of rubella vaccination in the national immunization schedule, there has been significant reduction of febrile rash episodes, cases of rubella, and congenital rubella syndrome.

Non-nutritive sucking habits, anterior open bite and associated factors in Brazilian children aged 30-59 months

The aim of the present study was to investigate the prevalence of non-nutritive sucking habits and anterior open bite as well as their main causes (associated factors) in Brazilian children aged 30-59 months. A cross-sectional study was carried out during the National Immunization Day for polio in the city of Recife in the northeastern region of Brazil. The sample was made up of 1,308 children. Data were collected from interviews with mothers or guardians as well as from clinical examinations carried out by previously trained dental students. The chi-square test was used for statistical analysis at 5% significance level. The prevalence of non-nutritive sucking habits was 40%, and the habits were associated with gender (p=0.001), age (p=0.003) and feeding type (p<0.001). Anterior open bite was detected in 30.4% of children, and it was significantly associated with feeding type (p<0.001) and non-nutritive sucking habits (p<0.001). The variables found to be associated factors in the present study for the occurrence of non-nutritive sucking habits and anterior open bite emphasize the need to establish strategies that include orientation regarding health promotion based on the “common determining factors” approach. Public health policies should be adopted to encourage a longer duration of breastfeeding, thereby contributing towards reducing the prevalence of non-nutritive sucking habits and anterior open bite.

OPV strains circulation in HIV infected infants after National Immunisation Days in Bangui, Central African Republic

BackgroundHumans are the only host of polioviruses, thus the prospects of global polio eradication look reasonable. However, individuals with immunodeficiencies were shown to excrete vaccine derived poliovirus for long periods of time which led to reluctance to prolong the vaccination campaign for fear of this end result. Therefore, we aimed to assess the duration of excretion of poliovirus after the 2001 National Immunization Days according to Human immunodeficiency virus status.FindingsFifty three children were enrolled. Sequential stool samples were collected in between National Immunisation Days rounds and then every month during one year. Children were classified into 2 groups: no immunodepression (n = 38), immunodepression (n = 15) according to CD4+ lymphocytes cells count. Thirteen poliovirus strains were isolated from 11 children: 5 Human immunodeficiency virus positive and 6 Human immunodeficiency virus negative. None of the children excreted poliovirus for more than 4 weeks. The restriction fragment length polymorphism analysis showed that all strains were of Sabin origin including a unique Polio Sabine Vaccine types 2 and 3 (S2/S3) recombinant.ConclusionsFrom these findings we assume that Human immunodeficiency virus positive children are not a high risk population for long term poliovirus excretion. More powerful studies are needed to confirm our findings.

Using oral polio vaccine beyond the cold chain: A feasibility study conducted during the national immunization campaign in Mali

We conducted the first systematic documentation of using oral polio vaccine (OPV) out of the cold chain during national immunization day (NID) campaigns in Mali. Using a crossover intervention design, vaccinators compared the transport of OPV in vaccine carriers with or without ice packs. Vaccine integrity was assured through monitoring vaccine vial monitor (VVM) status. Despite ambient temperatures up to 40 °C, none of the VVMs on any of the vials used ( n = 956) reached their discard point. Over 90% of vaccinators and supervisors preferred conducting NIDs without ice packs. In addition, using OPV out of the cold chain reduced vaccine wastage resulting from melting ice packs causing labels to detach from the vial.

Pakistan, politics and polio

Pakistan, politics and polio