National Vaccination Coverage Research Articles

Boundary Guided Semantic Learning for Real-Time COVID-19 Lung Infection Segmentation System

The coronavirus disease 2019 (COVID-19) continues to have a negative impact on healthcare systems around the world, though the vaccines have been developed and national vaccination coverage rate is steadily increasing. At the current stage, automatically segmenting the lung infection area from CT images is essential for the diagnosis and treatment of COVID-19. Thanks to the development of deep learning technology, some deep learning solutions for lung infection segmentation have been proposed. However, due to the scattered distribution, complex background interference and blurred boundaries, the accuracy and completeness of the existing models are still unsatisfactory. To this end, we propose a boundary guided semantic learning network (BSNet) in this paper. On the one hand, the dual-branch semantic enhancement module that combines the top-level semantic preservation and progressive semantic integration is designed to model the complementary relationship between different high-level features, thereby promoting the generation of more complete segmentation results. On the other hand, the mirror-symmetric boundary guidance module is proposed to accurately detect the boundaries of the lesion regions in a mirror-symmetric way. Experiments on the publicly available dataset demonstrate that our BSNet outperforms the existing state-of-the-art competitors and achieves a real-time inference speed of 44 FPS. The code and results of our BSNet can be found from the link of <uri xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">https://github.com/rmcong/BSNet</uri> .

Developing communication tools on rotavirus vaccination to support family paediatricians in Italy

BackgroundUniversal rotavirus (RV) vaccination for newborns was introduced in Italy in 2018, but national vaccination coverage is still suboptimal. Effective communication between the family paediatrician (FP) and parents/caregivers is essential to promote vaccination acceptance. This project aimed to support FPs in communicating RV vaccination to parents/caregivers through the development and implementation of demonstrative videos and training modules. MethodsA working group composed of two FPs, two communication professionals, a medical expert from GSK and a clinical psychologist, was formed to establish the key scientific information to be communicated to parents/caregivers and develop the demonstrative videos. Four videos depicting four communication styles (I to IV) were developed based on the Social Styles Theory. Thirty FPs were then asked to pilot test the videos and provide feedback. In addition, two training modules with scientific information were developed to learn how to respond to parents’/caregivers’ objections. ResultsA total of 23 FPs provided feedback after using one or more videos at least five times. Twenty FPs (87.0 %) used mostly-one style, and most (60.0 %) used Style IV. Overall, the feedback was positive, as the majority of FPs (82.6 %, n = 19/23) indicated that the proposed videos were ‘useful’ or ‘extremely useful’ for introducing the RV vaccination to parents/caregivers in their actual practice. Based on this feedback, shorter versions of each video were also produced, and two training modules were developed to support FPs in responding to parental objections. Most FPs 75 % (n = 9/12) found Module 1 ‘very useful’, and all found Module 2 ‘very useful’ (100 %, n = 12/12). ConclusionsThe communication tools developed were well appreciated by the FPs and are expected to support FPs in communicating RV vaccination thereby increasing its coverage. Practicing RV communication may also prove beneficial for FPs to communicate other critical topics to parents/caregivers.

Routine childhood vaccination in India from 2005–2006 to 2015–2016: Temporal trends and geographic variation

ObjectiveIndia has experienced a substantial increase in the coverage of routine childhood vaccines in recent years. However, a large fraction of these vaccines is not delivered in a timely manner, i.e., at the recommended age. Further, substantial disparities exist in both coverage and timeliness across states. We aim to quantify the changes in coverage and timeliness of routine childhood vaccination in India over time, their variation across states, and changes in these variations over time. MethodsWe used data from two rounds of India’s National Family Health Surveys, NFHS-3 (2005–06) and NFHS-4 (2015–16) on bacille Calmette–Guerin vaccine (BCG), three doses of diphtheria, pertussis, and tetanus vaccine (DPT1, DPT2, DPT3), and measles-containing vaccine (MCV). We used the Turnbull estimator to estimate the cumulative distribution function (CDF) of administering each vaccine by a certain age while accounting for two-sided censoring in the survey data. We then used these estimated CDFs to calculate coverage and timeliness at the national and state levels. FindingsAt the national level, both vaccination coverage and timeliness estimates increased from NFHS-3 to NFHS-4 for all vaccines. The increase in timeliness ranging from 27.3% for DPT3 to 74.0% for MCV continued to be lower than coverage, ranging from 75.3% (95% CI 57.7–87.2) for DPT3 to 74.0% (95% CI 42.2–33.0) for MCV, for all vaccines. Cross-state variation in timeliness was greater than the variation in coverage. Variation in both timeliness and coverage reduced from NFHS-3 to NFHS-4. However, this reduction was greater for timeliness than for coverage. ConclusionsA large fraction of the children in India receive vaccines later than the recommended age thereby keeping them exposed to vaccine-preventable diseases. Interventions that specifically focus on improving the timely delivery of vaccines are needed to improve the overall effectiveness of the routine immunization program.

Detection of poliovirus in London highlights the value of sewage surveillance

The discovery of poliovirus in London wastewater has garnered wide public interest and media attention. It serves as a reminder that until the virus is eradicated from the world, all countries are at risk of a resurgence if high vaccine coverage falters. The simultaneous detection of genetically linked poliovirus in New York, USA, and Israel indicates the likelihood that the virus has spread through international travel and emerged in geographically distant locations.1 This observation is unexpected as it involves high-income countries with exclusive use of the inactivated polio vaccine and high national vaccine coverage.

The impact of COVID-19 and catch-up strategies on routine childhood vaccine coverage trends in Latin America: A systematic literature review and database analysis

ABSTRACT Globally, an estimated 23 million children missed vaccination in 2020 due to the coronavirus disease 2019 (COVID-19) pandemic. We analyzed vaccination coverage trends and catch-up strategies/recommendations implemented in Latin America during the pandemic. We performed a national administrative database analysis and a systematic literature review to evaluate vaccination coverage data and identify catch-up strategies for missed vaccinations in selected countries in Latin America (Argentina, Brazil, Chile, Colombia, Mexico and Peru). Data were extracted from national health ministry vaccination coverage and supranational databases to identify coverage of rotavirus (RV), pentavalent/hexavalent, measles, Bacillus Calmette-Guérin (BCG) and pneumococcal conjugate vaccines (PCV) at country level before and during the COVID-19 pandemic. A systematic literature review of published papers was conducted to identify vaccination catch-up strategies published in January 2020–June 2021. National administrative database-reported data showed that vaccination coverage trends were declining prior to 2020. The change in vaccination coverage before and during the COVID-19 pandemic ranged from 2.5% to −11.5% (RV), −3.0% to −11.0% (measles), 1.5% to −7.5% (PCV), 9.0% to −14.0% (pentavalent/hexavalent), and 3.0% to −18.5% (BCG). Among 696 identified studies, 14 studies were included in this review. Catch-up vaccination strategies included prioritizing routine vaccinations as per the national immunization schedule. Overall vaccination coverage declined by varying degrees among the countries investigated. This trend was observed prior to 2020, suggesting multifactorial reasons for declining vaccination rates in Latin America.

Spatio-temporal predictions of COVID-19 test positivity in Uppsala County, Sweden: a comparative approach

Previous spatio-temporal COVID-19 prediction models have focused on the prediction of subsequent number of cases, and have shown varying accuracy and lack of high geographical resolution. We aimed to predict trends in COVID-19 test positivity, an important marker for planning local testing capacity and accessibility. We included a full year of information (June 29, 2020–July 4, 2021) with both direct and indirect indicators of transmission, e.g. mobility data, number of calls to the national healthcare advice line and vaccination coverage from Uppsala County, Sweden, as potential predictors. We developed four models for a 1-week-window, based on gradient boosting (GB), random forest (RF), autoregressive integrated moving average (ARIMA) and integrated nested laplace approximations (INLA). Three of the models (GB, RF and INLA) outperformed the naïve baseline model after data from a full pandemic wave became available and demonstrated moderate accuracy. An ensemble model of these three models slightly improved the average root mean square error to 0.039 compared to 0.040 for GB, RF and INLA, 0.055 for ARIMA and 0.046 for the naïve model. Our findings indicate that the collection of a wide variety of data can contribute to spatio-temporal predictions of COVID-19 test positivity.

National Vaccination Coverage Among Adolescents Aged 13-17 Years - National Immunization Survey-Teen, United States, 2021.

National Vaccination Coverage Among Adolescents Aged 13-17 Years - National Immunization Survey-Teen, United States, 2021.

SARS-CoV-2 Seroepidemiological Investigation in Jordan: Seroprevalence, Herd Immunity, and Vaccination Coverage. A Population-Based National Study.

BackgroundPopulation-based serosurveillance is a cornerstone to furthering our understanding of the COVID-19 pandemic at the community levels. In Jordan, four waves (phases) of seroprevalence epidemiological investigations were conducted using representative population-based national samples. This study aims to estimate the population-based seropositivity, herd immunity, and vaccination coverage at the fourth wave.MethodsMultistage sampling technique was implemented to recruit a nationally representative sample for the fourth wave of the seroprevalence investigation (June to August 2021). Electronically collected data utilized a questionnaire on background demographics, chronic diseases, and COVID-19 vaccination history. Also, blood samples were collected to detect the presence of total Anti-SARS-CoV-2 IgM and IgG using Wantai/ELISA assays. Prevalence estimates were presented using percentage and 95% Confidence Intervals (C.I.).ResultsThere were 8821 participants included in this study, with a mean age of 31.3 years, and 61.7% were females. COVID-19 national seroprevalence and vaccination coverage estimates were 74.1% (95% C.I.: 73.1–74.9%) and 38.4% (95% C.I.: 37.1–39.6%), respectively. Among children, seroprevalence estimates were similar to unvaccinated adults. Among COVID-19 adults, 57.2% were vaccinated. Among vaccinated participants, 91.5% were seropositive, while among unvaccinated, 63.2% were seropositive. By age group, seroprevalence ranged between 53.0% and 86.9%. Seroprevalence estimates were significantly different by gender, vaccination status and dose, and residence.ConclusionThe reported interplay between seropositivity and vaccination coverage estimate seems insufficient to provide herd immunity levels to combat new variants of SARS-CoV-2. Children and healthcare workers seem to be an epidemiologically influential group in spreading COVID-19. As the globe is still grappling with SARS-CoV-2 infection, national seroepidemiological evidence from Jordan calls for more focus on vaccination coverage, especially among epidemiologically vulnerable groups, to optimize herd immunity.

Evaluation of the 2018–2019 vaccine effectiveness against medically attended influenza-like illness using medical records and claims data

BackgroundHealthcare administrative databases are a rich source of information that could be leveraged to estimate real-world influenza vaccine effectiveness (VE). We aimed to evaluate the VE of standard egg-based influenza vaccines and determine if administrative healthcare data provide accurate VE estimates compared to the US CDC data. MethodsThis retrospective cohort study was conducted during the 2018–2019 influenza season. Individuals who had at least one relevant record per year between 2015 and 2019 in their electronic medical record were included. Individuals were considered protected 14 days after receiving an influenza vaccine. The outcome was the occurrence of medically attended influenza-like illness (MA-ILI) defined by clinical diagnostic codes. Adjusted odds ratios (aORs) were derived from multivariate logistic regression and adjusted VE (aVEs) were calculated using 100 × (1-aORs). ResultsA total of 5,066,980 individuals were included in the analysis with 1,307,702 (25.8%) considered vaccinated. Overall, the median age was 54 (IQR, 32–66) and 58.1% were female. Vaccine protection against MA-ILI was moderate in children and low in adults. All estimates were lower than VEs reported by the CDC for the 2018–2019 influenza season. Our results were robust to potential loss to follow up, but misclassification bias and residual confounding led to underestimation of the 2018–2019 aVE. When stratified by the number of primary care visits, aVE estimates and vaccination coverage increased with the number of primary care visits, reaching estimates similar to those obtained by the US CDC and US national vaccination coverage among those with ≥ 6 primary care visits, resulting in significant positive vaccine protection in frequent healthcare users. ConclusionsModerate and low aVEs were observed during the 2018–2019 season using administrative healthcare data, which was likely due to detection and misclassification biases, correlated with healthcare seeking behaviour, leading to an underestimation of the 2018–2019 influenza VE.

Does a pay-for-performance health service model improve overall and rural–urban inequity in vaccination rates? A difference-in-differences analysis from the Gambia

ObjectiveTo assess whether the implementation of a results-based financing (RBF) project in The Gambia resulted in (1) improved national vaccination coverage (2) higher coverage in intervention than non-intervention areas, and (3) improvement in rural–urban coverage inequality. MethodsThe study used a difference-in-differences design, based on repeated cross-sectional data from The Gambian Demographic and Health Surveys 2013 (N = 1650) and 2020 (N = 1456). Full vaccination (receipt of one BCG, 3 OPV, 3 DTP, and 1 measles-containing vaccine doses) and rural–urban vaccination inequality were our outcome variables. The intervention, RBF, was implemented in 5 of the 7 health regions. Covariates controlled for included child’s sex, child’s birth order number, socioeconomic status, ethnicity, distance from health facility, maternal education, mother’s age group, mother’s marital status, and mother’s work status. Poisson regression with robust variance was used to estimate whether coverage changed, and difference-in-differences and difference-in-differences-in-differences were used to ‘assess differences in vaccination coverage change and change in inequalities, respectively. ResultsTotal crude full vaccination coverage in The Gambia was 76% in 2013 and 84.6% in 2020. Overall vaccination significantly increased by 16% (95% CI: 9% to 24%) in 2020 compared to 2013, but with a smaller increase in intervention relative to non-intervention areas [PRR 0.88 (CI: 0.78–0.99)]. Rural-urban inequality in vaccination coverage decreased more – by 13% [0.87 (0.78–0.98)] – in RBF than non-RBF regions. ConclusionVaccination coverage improved over the study period though we have no evidence to ascribe the coverage gains to the RBF intervention. However, our study suggests that the RBF project has contributed to reducing rural–urban inequalities in the regions it was implemented.

Estimating the health workforce requirements and costing to reach 70% COVID-19 vaccination coverage by mid-2022: a modelling study and global estimates

ObjectivesThe implementation of COVID-19 vaccination globally poses unprecedented stress to health systems particularly for countries with persisting health workforce shortages prior the pandemic. The present paper estimates the workforce requirement...

Mapping BCG vaccination coverage in Ethiopia between 2000 and 2019

IntroductionThe Bacille-Calmette–Guerin (BCG) vaccination remains the primary strategy to prevent severe disseminated TB in young children, particularly in high TB-burden countries such as Ethiopia. Accurate knowledge of vaccination coverage in small geographical areas is critically important to developing targeted immunization campaigns. Thus, this study aimed to investigate the spatiotemporal distributions and ecological level determinants of BCG vaccination coverage in Ethiopia.MethodBacille-Calmette–Guerin immunization coverage and geographical information data were obtained from five different Demographic and Health Surveys, conducted in Ethiopia between 2000 and 2019. Data for independent variables were obtained from publicly available sources. Bayesian geostatistical models were used to predict the spatial distribution of BCG vaccination coverage in Ethiopia.ResultThe overall national BCG vaccination coverage between 2000 and 2019 was 65.5%. The BCG vaccine coverage was 53.5% in 2000, 56.9% in 2005, 64.4% in 2011, 79.6% in 2016, and 79.0% in 2019. BCG vaccination coverage increased by 47.6% in Ethiopia from 2000 to 2019, but substantial geographical inequalities in BCG coverage remained at sub-national and local levels. High vaccination coverage was observed in northern, western, and central parts of Ethiopia. Climatic and demographic factors such as temperature, altitude, and population density were positively associated with BCG vaccination coverage. Whereas, healthcare access factors such as distance to health facilities and travel time to the nearest cities were negatively associated with BCG vaccine coverage in Ethiopia.ConclusionDespite substantial progress in national BCG vaccination coverage, marked spatial variation in BCG coverage persists throughout the country at sub-national and local levels. Healthcare access and climatic and demographic factors determined the spatial distribution of BCG vaccination coverage. Maintaining a high level of vaccination coverage across geographical areas is important to prevent TB in Ethiopia.

Long-term surveillance of rotavirus vaccination after implementation of a national immunization program in Finland (2008–2018)

BackgroundRotavirus (RV) vaccination was included in the Finnish National immunization Program (NIP) in 2009. RotaTeq (RV5) has been used exclusively with a national average vaccination coverage rate (VCR) of > 90%. While previous studies have demonstrated that inpatient rotavirus gastroenteritis (RVGE) admissions declined by as much as 96% in Finnish children ≤ 5 years old following RV vaccination introduction, no study has evaluated long-term protection after vaccination in Finland. In this study, we analyze incidence of hospital outpatient visits and inpatient admissions of gastroenteritis in children up to 7 years of age. MethodsWe first describe the incidence of RVGE, viral gastroenteritis (VGE), and acute gastroenteritis (AGE) for all Finnish children born during 2008–2011. Children were stratified by the year of birth into not-eligible, partially eligible and rotavirus vaccine-eligible (born in 2008, 2009, 2010 and 2011, respectively). Hospital inpatient and outpatient data was collected from the National Care Register for all children from birth until December 31st, 2018. We also studied RVGE incidence during 2014–2017 for children<3 years of age in municipalities with VCRs of 90% and above and municipalities with VCRs below 90%. ResultsRVGE incidence decreased significantly soon after implementation of RV vaccination in the NIP. In vaccine-eligible cohorts, no clear peak incidence in the youngest age groups could be observed, and no RVGE cases were observed beyond 6 years after vaccination, in contrast to vaccine ineligible and partially eligible cohorts. Despite an overall high VCR in Finland, regions with high VCR had lower incidence of RVGE than regions with lower VCR. ConclusionIncidence of RVGE has remained low in all age groups during the 10 years following introduction of RV vaccine in the Finnish NIP. Differences in RVGE incidence were observed in regions with high as compared with lower VCR, highlighting the importance of maintaining high vaccination coverage.

Call based enquiry for COVID-19 vaccine (Covishield) adverse events in a tertiary care government hospital in India

Background: Vaccination is one of the crucial intervention to fight against the ongoing COVID-19 pandemic. The ongoing vaccination drive aims for achieving national vaccination coverage. Due to the expedited roll out of COVID-19 vaccine, there has been a fear and concern regarding its safety. The present study aims to enquire actively about the adverse events after COVID-19 vaccination and disseminate this information to the public to promote vaccine acceptance.Methods: A call based active enquiry was done to know the frequency and severity of various adverse events among the recipients of COVID-19 vaccine’s Covishield (SII-ChAdOx1 nCoV-19) first dose. Call based enquiry was done for local as well as systemic adverse events on day 1, 3 and 7 of vaccination.Results: Out of the total of 1201 who responded to calls on all three days, 766 (63.7%) of them had at least one of the adverse event. There were only 4 (0.33) recipients who had severe/serious events. The most frequent systemic and local AEFI reported was body ache/ malaise and pain at injection site in 309 (25.7%) and 664 (55.3%) participants respectively. Most of the AEFI’s improved over a week with only 17 (1.4%) participants reporting persistence of any adverse event on day 7 of vaccination.Conclusion: Our study can provide scoping base for development of a proper surveillance program to monitor the AEFI by ‘active’ query and use of a call-based system especially for novel vaccines.

A tool for early estimation of influenza vaccination coverage in Spanish general population and healthcare workers in the 2018\u201319 season: the Grip\xf3metro

AsbtractBackgroundElectronic vaccine registries are not yet widely established. There is a need to real-time monitor influenza vaccine coverage, which may raise awareness to risk groups and professionals, and eventually allow to adopt tailored measures during the vaccination campaign. To evaluate the utility of the “Gripómetro”, a demographic study designed to monitor national and regional influenza vaccine coverage on a weekly basis in Spain.MethodsQuantitative study based on surveys of the Spanish population between 18–80 years and a sample of primary care doctors and nurses randomly selected. Pre-proportional fixation has been established by Autonomous Communities and age group to guarantee the representativeness of all the autonomies.ResultsInterviews were conducted in 3400 households of general population and 807 respondents among health care professionals. We found that the results of influenza vaccination coverage in the population ≥ 65 years obtained by the Gripómetro for 2018–2019 season were mostly comparable with the official data presented by the Ministry of Health after the end of the vaccination campaign.ConclusionsThe Gripómetro is a robust research method that provides real-time data and trends for influenza vaccine coverage along with other useful information related to vaccination such as intention to vaccinate, motivation and barriers to vaccination.

National and regional variations in timely adherence to recommended measles vaccination scheme in 2-years old in Switzerland, 2005–2019

BackgroundAlthough monitoring of vaccination program performance is usually evaluated by measurement of vaccine coverage, timely uptake is rarely part of this assessment. This study aims to examine the timeliness of the administration of a measles-containing-vaccine (MCV) for 2-year-old children between 2005 and 2019. MethodsWe used data from the Swiss National Vaccination Coverage Survey 2005–2019 for the study. We defined timely vaccinated as a vaccination administered within the recommended age specified in the Swiss National Vaccination Schedule, with an added tolerance period of 30.4 days for both MCV 1 and 2 doses. The median delay time was estimated by Kaplan-Meier survival curve and examined using log-rank test. A Cox hazard ratio was used to identify factors associated with delay. Results81% (95% CI:79–82%) of toddlers were timely vaccinated for MCV1 and 82% (95% CI:81–83%) for MCV2 in survey period 2017–2019. Between 2005 and 2019, the median age of vaccinated children ranged between 12.2 and 12.5 and 18.3–22.0 months for MCV1 and MCV2 with median delay of 44 and 38 days, respectively, at the national level. Children in the French-, Italian- and German-speaking regions were vaccinated earlier between 2005 and 2019 for MCV1 (vaccination coverage range before 10 months of age: 1.7–45.9%, 1.2–35.3% and 1.4–15.0%, respectively). Nationality, linguistic regions, and survey periods were the strongest predictive factors related to prolonged delay time. ConclusionOverall adherence to recommendations has improved over time, as MCV coverage has significantly increased over the years with differences across linguistic regions. Vaccinations were administered earlier and with shorter delay time.

Dissecting recurrent waves of pertussis across the boroughs of London.

Pertussis has resurfaced in the UK, with incidence levels not seen since the 1980s. While the fundamental causes of this resurgence remain the subject of much conjecture, the study of historical patterns of pathogen diffusion can be illuminating. Here, we examined time series of pertussis incidence in the boroughs of Greater London from 1982 to 2013 to document the spatial epidemiology of this bacterial infection and to identify the potential drivers of its percolation. The incidence of pertussis over this period is characterized by 3 distinct stages: a period exhibiting declining trends with 4-year inter-epidemic cycles from 1982 to 1994, followed by a deep trough until 2006 and the subsequent resurgence. We observed systematic temporal trends in the age distribution of cases and the fade-out profile of pertussis coincident with increasing national vaccine coverage from 1982 to 1990. To quantify the hierarchy of epidemic phases across the boroughs of London, we used the Hilbert transform. We report a consistent pattern of spatial organization from 1982 to the early 1990s, with some boroughs consistently leading epidemic waves and others routinely lagging. To determine the potential drivers of these geographic patterns, a comprehensive parallel database of borough-specific features was compiled, comprising of demographic, movement and socio-economic factors that were used in statistical analyses to predict epidemic phase relationships among boroughs. Specifically, we used a combination of a feed-forward neural network (FFNN), and SHapley Additive exPlanations (SHAP) values to quantify the contribution of each covariate to model predictions. Our analyses identified a number of predictors of a borough’s historical epidemic phase, specifically the age composition of households, the number of agricultural and skilled manual workers, latitude, the population of public transport commuters and high-occupancy households. Univariate regression analysis of the 2012 epidemic identified the ratio of cumulative unvaccinated children to the total population and population of Pakistan-born population to have moderate positive and negative association, respectively, with the timing of epidemic. In addition to providing a comprehensive overview of contemporary pertussis transmission in a large metropolitan population, this study has identified the characteristics that determine the spatial spread of this bacterium across the boroughs of London.

Tdap Booster Vaccination for Adults: Real-World Adherence to Current Recommendations in Italy and Evaluation of Two Alternative Strategies.

Background: While the effectiveness of tetanus-diphtheria-pertussis childhood immunization programs is unquestionable, the actual need for a periodic boosting vaccination in adults is controversial. In Italy, the Ministry of Health recommends a Tdap booster vaccination every 10 years. The aim of this study is to assess the real-world adherence of Italian regional healthcare services to national recommendations and to evaluate two alternative strategies. Methods: Annual Tdap vaccine requirements by the 21 Italian regions were retrieved from related tender announcements, and regional and national vaccination coverage rates (VCRs) were estimated for three scenarios, namely the currently recommended 10-year booster vaccination, a single booster shot at age 50 and at age 65. Results: In Scenario 1, no region reached a VCR > 30%, and the national VCR was 10.6%; in Scenario 2, five regions achieved the optimal vaccination coverage of ≥95%, but the vast majority continued to have inadequate VCRs, with a national VCR of 54.4%; in Scenario 3, five regions reached VCRs exceeding 100%, with VCRs from other regions significantly improving and a national VCR of 74.8%. Conclusions: A substantial lack of adherence by Italian regional healthcare services to current national recommendations on tetanus-diphtheria-pertussis adult vaccination was shown. Scenario 3 is the most feasible, i.e., a single booster shot at age 65, possibly administrable along with other already-recommended, age-specific vaccines.

An Independent Study to Compare Compliance, Attitudes, Knowledge, and Sources of Knowledge about Pneumococcal Vaccinations among an Italian Sample of Older Adults

Background: Streptococcus pneumoniae is one of the leading causes of pneumoniae deaths, especially among elderly individuals, with the vaccine being the primary prevention instrument. However, information on national vaccine coverage among the elderly population is scarce and sparse. Methods: A survey involved a representative sample of Italians older than 65 years (n = 600), who agreed to participate in the study through a phone interview. Participants’ self-reported pneumococcal vaccination status, vaccine literacy, information source, and risk perception related to the infection and to vaccines-adverse reactions were assessed. Results: The reported vaccination status is very low (11.2%), with respondents largely uninformed about vaccination opportunities. The results also show that the predominant (and most effective) source of information is healthcare providers, with vaccine hesitancy being positively linked to risk perception related to disease and negatively linked to risk perception of vaccine adverse reactions. Conclusions: This study suggests the need to collect data to systematically monitor vaccination coverage and calls for information campaigns to improve elderly literacy to increase vaccination uptake.

Cross-country evidence on the role of national governance in boosting COVID-19 vaccination

BackgroundFrequent mutations of the COVID-19 virus, such as the Delta and Omicron variants, have prolonged the pandemic. Rich countries have approved the booster shots (3rd doses) of vaccine, but this causes further delay of vaccination in developing countries. This raises the risk of further mutations, which may lower the efficacy of currently available vaccines. As herd immunity by universal vaccination is essential to end the pandemic, the COVID-19 Vaccine Global Access (COVAX) facility has been established to provide developing countries with subsidized vaccines. However, a critical issue is that the developing countries also need to effectively deploy vaccines to citizens. Although this argument suggests positive effects of good national governance on vaccination coverage, to the best of our knowledge, there is no cross-country evidence on the role of national governance in increasing the coverage of COVID-19 vaccines among citizens. The goal of this study was to examine the association between the national governance and vaccination coverage among developing countries.MethodsUsing cross-country data, an ordinary least squares regression was conducted to examine the association between the national governance index and three outcomes: (1) the number of days until the administration of the first dose in the country since December 2019, (2) the number of doses per 100 citizens as of the end of July 2021, and (3) the selection of approved vaccine manufacturers. The results were compared between the model including all countries and the model excluding the member countries of Organisation for Economic Co-operation and Development (OECD).ResultsA one standard deviation increase in the national governance index was associated with 9.1 days (95%CI: -15.76, -2.43) earlier administration of vaccines in the country, and a 12.1 dose increase (95%CI: 4.76, 19.34) per 100 citizens. These associations were larger in the non-OECD sample. The results also indicated the role of governance in the selection of the administered vaccines.ConclusionThe provision of subsidized vaccines alone is not sufficient to control the spread of infection in developing countries; logistical and administrative support should also be offered, especially in countries with poor governance.Trial registrationNot applicable