Opportunities For Vaccination Research Articles

Prevalence and factors contributing to missed opportunities for vaccination in Mogadishu, Somalia

BackgroundVaccination is a critical public health intervention that significantly reduces morbidity and mortality from vaccine preventable diseases. Despite the proven benefits of vaccines, missed opportunities for vaccination (MOV) remain a significant challenge in many low-income countries, including Somalia. This study aimed to determine the prevalence and identify the factors contributing to MOV in Mogadishu, Somalia. MethodsA cross-sectional study was conducted at various healthcare facilities in Mogadishu, Somalia, from January to March 2024. A total of 234 caregivers of children under five years of age were interviewed using a structured questionnaire. Data on sociodemographic characteristics, health service utilization, and reasons for missed vaccinations were collected. Logistic regression analysis was used to identify factors associated with MOV. Results: The prevalence of MOV in Mogadishu was 26%. Key factors contributing to MOV included low socioeconomic status, lack of caregiver awareness about vaccination schedules, logistical challenges within the healthcare system, and misconceptions about vaccine safety and efficacy. Knowledge and beliefs of mothers about vaccination significantly affected the MOVs in children. Not knowing if all children should be vaccinated is associated with higher probability of (MOVs), (AOR =13.006, 95% CI = 1.175-143.924, p = 0.003). ConclusionThe study highlighted a significant prevalence of missed opportunities for vaccination in Mogadishu, Somalia. Addressing these missed opportunities requires a multifaceted approach, including enhancing public awareness about the importance of vaccination, improving healthcare infrastructure, and ensuring consistent vaccine supply and proper storage.

Differences in knowledge, attitudes and intentions towards HPV vaccination among young adults from diverse socio-cultural groups in Israel: A cross-sectional study

In Israel, The Human Papilloma Virus (HPV) vaccine is recommended to both genders up to age 26. Many 18–26 olds missed their opportunity for vaccination during school. Our study described HPV knowledge, attitudes and vaccination intentions among unvaccinated 18–26 Israeli adults across various demographics, aiming to inform future catch-up vaccination strategies.We recruited participants through an anonymous survey and collected information about demographics and HPV knowledge, attitudes and intentions using questions from validated questionnaires adapted to the Israeli context, distributed between December 2023–February 2024. We calculated weighted mean knowledge and attitude scores according to age, gender, ethnicity and sexual orientation. We determined factors associated with vaccination knowledge, attitudes and intentions using multivariate linear regressions.Of 4324 respondents, 36 % were vaccinated. Of 1994 unvaccinated individuals included in the final analysis, <50 % reported being familiar with HPV. The overall mean weighted HPV knowledge score was 9.5/14 (95 % CI 9.3–9.7). Older participants, Jewish non-Ultra-Orthodox, and those with higher education levels reported higher knowledge scores. Attitudes towards HPV vaccination were generally neutral but tended towards the positive, with an overall mean weighted score of 2.9/5 (95 %CI 2.88–2.95). Variation in attitudes across different demographic groups was minimal.Intention to vaccinate within 12 months was low, with <15 % of respondents overall expressing an intention to do so. Factors significantly associated with higher vaccination intention included being Arab, older, female, having multiple sexual partners, and being a student. There was no association between sexual orientation and vaccination intention. Arab participants showed the highest intention to vaccinate despite having the lowest knowledge levels.Young adults in Israel demonstrate low HPV awareness and vaccination intention, with minor variations in attitudes across different demographics. Providing more information may be insufficient to increase vaccine uptake in all groups. Future catch-up campaigns should be tailored to barriers specific to different groups.

Improving the last mile delivery of vaccines through an informed push model: Experiences, opportunities and costs based on an implementation study in a rural district in Uganda.

Developing countries face challenges in ensuring equitable, timely, and efficient vaccine availability at health facilities. In Uganda, the distribution of vaccines from district stores to the last-mile health facilities is hindered by an unpredictable and unreliable mixed push-pull delivery system. This system often results in poor vaccine management, stock-outs, and missed vaccination opportunities. This pilot study aimed to enhance the efficiency of last-mile vaccine delivery by implementing an informed push model. The specific goals were to improve vaccine lead time, standardize cold chain management during transportation, and evaluate the costs of implementing the informed push model. A mixed methods approach was used to evaluate the impact of the informed push model in Gomba district, Uganda. Both quantitative and qualitative data were collected at baseline and endline. Quantitative data included mode, frequency, lead-time, and costs of vaccine delivery, vaccine stock status, and cold chain maintenance during transportation, gathered through semi-structured interviews. Qualitative data on experiences and challenges were collected using a guide. Descriptive statistics were used for quantitative data analysis, while an ingredients approach was used for costing data. Thematic analysis was applied to qualitative data. The informed push system significantly improved vaccine delivery efficiency and quality in Gomba district. The average lead-time for vaccine delivery reduced from 14 days at baseline to 5 days at endline. Timely vaccine receipt at health facilities increased from 36.8% to 100%. Temperature monitoring during transit improved from 26.3% to 100%. The proportion of facilities experiencing stock-outs dropped from 79.0% to 36.8%. Monthly distribution costs decreased from $494.8 ($0.07 per child) to $445.9 ($0.06 per child). The informed push model is a cost-effective strategy for improving last-mile vaccine delivery by reducing lead times, enhancing cold chain management, and decreasing stock-outs. Integration into the national immunization program is recommended for broader adoption in Uganda.

Zero-dose children in Latin America: analysis of the problem and possible solutions

Introduction Zero-dose children (ZDC) are defined as those that have never been reached by routine immunization services. In Latin America, almost 2.7 million infants younger than 1 year of age, have incomplete vaccination schedules, and vaccine preventable diseases such as measles or polio have increase worldwide. ZDC are reported to reside in high risk and fragile settings, including remote-rural areas, urban slums, and conflict-affected areas. Identifying the problem and settings in each country is mandatory to propose possible solutions to the immunization coverage situation. Areas covered In November 2023, a group of experts of the Latin America Society of Pediatric Infectious Diseases (SLIPE) analyzed the global and regional reality of ZDC, and present in this document an updated reality of the Latin American region and the weight of the possible interventions to overcome this problem. Expert commentary Communication is a key element to improve vaccination coverage, as it is quality and use of vaccination data. Campaigns that deliver targeted and effective messages to communities and families, provide education about vaccination, avoid missed vaccination opportunities, and coordinate efforts across different sectors and communities, among other strategies, could improve the current immunization situation.

Measles Population Immunity Profiles: Updated Methods and Tools.

Measles is a highly contagious disease and remains a major cause of child mortality worldwide. While measles vaccine is highly effective, high levels of population immunity are needed to prevent outbreaks. Simple but accurate tools are needed to estimate the profile of population measles immunity by age to identify and fill immunity gaps caused by low levels of vaccination coverage. The measles immunity profile estimates and visualizes the percentage of each birth cohort immune or susceptible to measles based on measles vaccination coverage. Several tools that employed this approach have been developed in the past, including informal unpublished versions. However, these tools used varying assumptions and produced inconsistent results. We updated the measles population immunity profile methodology to standardize and better document the assumptions and methods; provide timely estimates of measles population immunity; and facilitate prompt actions to close immunity gaps and prevent outbreaks. We recommend assuming that the second dose of the measles-containing vaccine (MCV2) and doses given during supplementary immunization activities (SIAs) first reach children who have been previously vaccinated against measles, so that previously unvaccinated children are reached only when the coverage of MCV2 or SIA is higher than the coverage achieved by all previous measles vaccination opportunities. This updated method provides a conservative estimate of immunization program impact to assess measles outbreak risk and to facilitate early planning of timely preventive SIAs to close population immunity gaps.

Empowering Women's Health: Examining the Impact of Human Papillomavirus (HPV) Vaccination on Cervical Cancer Treatment and Beyond.

This study aims to identify the change in the health status of women, particularly in cervical cancer treatment through HPV vaccination. Thus, the research aims to measure the reduction in the incidence of cervical cancer in vaccinated women and evaluate the impact of HPV vaccination on the overall health and well-being of women treated for cervical cancer. The paper uses a research approach that involves reviewing the literature, analysing epidemiological data, and assessing the impact of the vaccination program. Major observations suggest that many developed countries' campaigns have reduced cervical cancer and enhanced treatment. Further, the study also addresses some additional effects of the intervention, both health-related with an emphasis on the decrease in healthcare costs and an enhancement of the quality of life among women, and social with a focus on the changes in women's status as a result of vaccination. The research also focusses on the community and economic points of view on HPV vaccination programs, its problems and opportunities regarding socio-economic factors, cultural disparities, and healthcare systems. This study implies that working on those barriers by implementing effective interventions, increasing awareness, and demanding relevant changes in policies could improve vaccination levels as well as outcomes. Hence, this research supports HPV vaccination as vital to the future health status of women. Through the use of survey data and the adoption of a public health perspective, the study can fill existing gaps in the literature on preventive interventions and cervical malignancies and consequently contribute to the enhancement of women's health, particularly in developing countries.

Addressing Missed Opportunities for Vaccination among Children in Hospitals: Leveraging the P-Process for Health Communication Strategies.

Addressing missed opportunities for vaccination requires a nuanced and context-specific approach. The five-step P-Process provides a robust framework to develop a clearly defined strategy that addresses social and behavioral drivers, integrates into existing health delivery systems, and facilitates collaboration with local experts. This approach allows teams to design, implement, monitor, and evaluate strategies to address public health issues. However, its specific application in vaccination communication programs remains relatively underexplored and under-documented. Our team designed a multi-pronged communication intervention aimed at enhancing vaccine uptake among hospitalized children in two tertiary hospitals in India and Nigeria. In the Inquiry stage, we conducted in-depth interviews with caregivers of hospitalized children to assess barriers to vaccination in a hospital setting. In the Strategic Development stage, we developed a blueprint for activities, identifying target audiences and communication channels and developing implementation plans. During the Create and Test stage, we brought together a range of stakeholders to co-develop a communication intervention through human-centered design workshops, after which we piloted the materials in both hospitals. We then Mobilized and Monitored progress of the activities to identify potential gaps that our materials did not initially address. Lastly, in the Evaluate and Evolve stage, we conducted in-depth interviews with healthcare workers and caregivers to measure outcomes and assess the impact on caregivers' decisions to vaccinate their hospitalized children. By following the P-Process for the design, caregivers reported that many of their concerns about vaccines were alleviated, and HCWs reported that they were able to communicate with caregivers more effectively about vaccination. By harnessing the power of the P-Process, researchers can forge a context-specific path towards impactful vaccination communication interventions, one step at a time.

Varicella-Zoster Virus Pretransplant Vaccination and Posttransplant Infections Among Pediatric Solid Organ Recipients in the Two-Dose Varicella Era: A Single-Center, Multi-Organ Retrospective Study.

Varicella-zoster virus (VZV) pretransplant immunization rates, exposures, and posttransplant disease are poorly characterized among pediatric solid organ transplant (SOT) recipients in the two-dose varicella vaccine era. A retrospective analysis of the electronic health records among children <18 years old who received SOT from January 1, 2011 through December 31, 2021, was performed at a single center to assess for missed pretransplant varicella vaccination opportunities, characterize VZV exposures, and describe posttransplant disease. Among 525 children, 444 were ≥6 months old (m.o.) at SOT with a documented VZV vaccine status. Eighty-five (19%) did not receive VZV Dose One; 30 out of 85 (35%) could have been immunized. Infants 6-11 m.o. accounted for 14 out of 30 (47%) missed opportunities. Among children ≥12 m.o. with documented Dose Two status (n = 383), 72 had missed vaccination opportunities; 57 out of 72 (79%) were children 1-4 years old. Most children had unclassifiable pre-SOT serostatus as varicella serology was either not obtained/documented (n = 171) or the possibility of passive antibodies was not excluded (n = 137). Of those with classified serology (n = 188), 69 were seroimmune. Forty-seven of 525 (9%) children had recorded VZV exposures; two developed varicella-neither had documented pre-SOT seroimmunity nor had received post-exposure prophylaxis. Nine additional children had medically attended disease: four primary varicella and five zoster. Of the 11 cases, 10 had cutaneous lesions without invasive disease; one had multi-dermatomal zoster with transaminitis. Seven (64%) received treatment exclusively outpatient. VZV exposure and disease still occur. Optimizing immunization among eligible candidates and ensuring patients have a defined VZV serostatus pretransplantation remain goals of care.

"That Was an Eye Opener for Me": Mixed-Methods Outcomes Educating Texas Community Health Workers on HPV Vaccination Using Project ECHO®.

Human papillomavirus (HPV) is known to cause six different types of cancer. HPV vaccination can prevent over 90% of these cancers. Community health workers (CHWs) have the potential to drive HPV vaccination demand through education and navigation by addressing vaccine hesitancy and dis/misinformation and by reaching non-English speaking, vulnerable, or rural populations. Despite their possible reach, there is limited research on HPV vaccination education programs for CHWs. In 2020-2021, the American Cancer Society (ACS) HPV Cancer Free Texas (HPVCFT) Project implemented the eight-session Mission: HPVCFT Vaccination ECHO-CHW Program ten times. This manuscript details the program's implementation processes and outcomes. The program used the Project ECHO model and was offered in both English and Spanish. One hundred and forty-six Texan CHWs completed pre- and post-training surveys. The participants demonstrated significant HPV vaccination knowledge increases and desirable shifts in their foundational HPV vaccination beliefs, including the belief that the HPV vaccine is for cancer prevention. The participants also reported increased confidence in communicating about the HPV vaccine in the community. Improving knowledge, beliefs, and confidence in HPV vaccination is the first step in addressing concerns and increasing uptake. Future research and interventions are needed to better understand how CHWs can be more systematically linked to vaccination opportunities or provided with clearer paths for directing patients to providers that vaccinate.

Implementation of the vaccination program in Guinea-Bissau: Coverage and missed opportunities for BCG at birth

BackgroundThe Bacillus Calmette-Guérin (BCG) vaccine is recommended at birth in Guinea-Bissau but often given with delay. Delays are not evident in routine coverage estimates since coverage is measured by 12 months of age. Studies show that BCG protects against other infections than tuberculosis and lowers neonatal mortality. Hence, the timing of BCG is important since the children should benefit from these non-specific effects as early as possible. MethodsUsing data from a nationally representative health and demographic surveillance system in Guinea-Bissau, we assessed BCG coverage at birth (within the first 3 days of life), 1 month, and 12 months for children born in 2013–19. We measured the proportion of children who had a documented health system contact within the first 3 days of life, thus an opportunity for BCG at birth, and whether the opportunities were utilized. In binomial regression models, we investigated factors associated with missed opportunities for vaccination. ResultsAmong the 22,178 children only 19 % were vaccinated at birth. By 1 month and 12 months, BCG coverages were 64 % and 93 %. The timeliness of BCG improved over time, with coverage at birth increasing from 16 % in 2013 to 25 % in 2019 and 1-month coverage from 63 % in 2013 to 75 % in 2019. If all vaccination opportunities had been utilized, the BCG coverage at birth could have reached 45 % (in the 1-month cohort) instead of the actual coverage of 19 %, as only 40 % of the vaccination opportunities were utilized. Region of residence was associated with having a missed opportunity for vaccination. ConclusionThe high coverage estimates at 12 months falsely imply that the vaccine is being administered according to the recommended schedule. Our findings suggest that early coverage could be markedly improved by ensuring that children are vaccinated at their first contact with the health system.

Routine Vaccination During Pregnancy Among People Living With HIV in the United States

Pregnancy represents a window of opportunity for vaccination due to established maternal and fetal benefits of vaccination. Little is known about receipt of routinely recommended vaccines in pregnancy, specifically tetanus, diphtheria, plus acellular pertussis (Tdap) and influenza, among pregnant people living with HIV (PLHIV). To estimate prevalence of vaccination receipt among pregnant people with HIV (PLHIV) and identify demographic and clinical characteristics associated with vaccination. This multicenter cohort study included women participating in Women's Health Study (WHS) of the Surveillance Monitoring for ART Toxicities (SMARTT) Study of the Pediatric HIV/AIDS Cohort Study. The network has been enrolling pregnant PLHIV at 22 US sites since 2007. Participants for this study enrolled between December 2017 and July 2019. Data analysis was conducted from October 2021 to March 2022. Data on vaccination in pregnancy were collected through medical record abstraction. Vaccination receipt was defined as Tdap vaccination received at less than 36 weeks' gestation and influenza vaccination at any gestational age, based on current guidelines. Log-binomial and modified Poisson regression models with generalized estimating equations were fit to identify factors associated with successful receipt of (1) Tdap, (2) influenza, and (3) both vaccinations. A total of 310 pregnancies among 278 people participating in the WHS were included (mean [SD] age, 29.5 [6.1] years; 220 [71%] Black, 77 [25%] Hispanic, and 77 [25%] race and ethnicity other than Black; 64 [21%] with perinatally acquired HIV). Less than one-third of pregnancies were vaccinated as recommended (Tdap, 32.6% [95% CI, 27.4%-38.1%]; influenza, 31.6% [95% CI, 26.5%-37.1%]; both, 22.6% [95% CI, 18.0%-27.6%]). People living with perinatally acquired HIV, those who did not identify as Black, or those who were multiparous had adjusted risk ratios (aRRs) less than 1, while older PLHIV had aRRs greater than 1, but these differences did not reach statistical significance (perinatally acquired HIV: adjusted risk ratio [aRR], 0.46; 95% CI, 0.21-1.02; race other than Black: aRR, 0.53; 95% CI, 0.26-1.08; multiparous: aRR, 0.59; 95% CI, 0.35-1.00; age 24-29 years: aRR, 2.03; 95% CI, 0.92-4.48). In this diverse, multicenter cohort of pregnant PLHIV, receipt of recommended vaccinations was low. Identifying and addressing barriers to vaccination receipt is urgently needed for pregnant people with HIV.

Missed opportunities for human papillomavirus vaccination using Iowa's Immunization Registry Information System.

Adolescent human papillomavirus (HPV) vaccination rates continue to remain lower than other adolescent vaccines, both nationwide and in Iowa. This study examined predictors of missed opportunities for first-dose HPV vaccine administrations in Iowa in order to conduct more targeted outreach and improve adolescent HPV vaccine uptake. A retrospective study was conducted to identify predictors of missed opportunities for first-dose HPV vaccination in Iowa adolescents using Iowa's Immunization Registry Information System. The study population included 154,905 adolescents aged 11-15 years between 2019 and 2022. Missed opportunity for first-dose HPV vaccination was defined as a vaccination encounter where an adolescent received a Tdap and/or MenACWY vaccine but did not receive the first-dose HPV vaccine during the same encounter. Over a third of the study population experienced a missed opportunity for HPV vaccination between 2019 and 2022. Missed opportunity for vaccination was most common among individuals living in a rural county (aOR = 1.36), underinsured adolescents (aOR = 1.74), males (aOR = 1.12), teens 13-15 years of age (aOR = 1.76), and White race and non-Hispanic ethnicity. This study builds on previously reported predictors of missed opportunity for HPV vaccination in adolescents. Increased understanding of provider needs and barriers to administering HPV vaccination and further analysis of how the Vaccines for Children Program can play a role in HPV vaccination uptake is necessary to improve HPV vaccination rates among adolescents in Iowa and more specifically in rural communities.

Factors Influencing Missed Opportunities in Infant Vaccination Among Children Aged 0-23 Months Within the Hohoe Municipality in The Volta Region, Ghana: A Facility-Based Study

Background Immunization is a vital public health strategy to enhance child survival by addressing significant diseases that cause child mortality. Annually, over 31 million children under five in sub-Saharan Africa are affected by vaccine-preventable conditions, with more than half a million dying due to lack of access to necessary vaccines. This study explored the factors contributing to Missed Opportunities for Vaccination (MOV) among caregivers of children aged 0-23 months in the Hohoe municipality. Methods The study employed a cross-sectional design. Structured questionnaires were administered to caregivers of children aged 0-23 months in selected health facilities in the Hohoe municipality. Three hundred seventy-eight caregivers aged 18 years and above participated in the study. Results The prevalence of MOV was found to be 22.2%. Factors predicting MOV included respondent’s age, marital status, parity status, knowledge and attitude. Younger mothers were more likely to have missed opportunities in infant vaccination [aOR=0.20(0.09,0.43) p&lt;0.001]. Being unmarried and having a large family size also contributed to missed opportunities in infant vaccination [aOR=2.0(1.12,3.44) p= 0.019] and [aOR=5.80(2.67,12.6) p=&lt;0.001] respectively. Conclusion MOV is prevalent in many settings and hinders immunization coverage. Age, number of children and family size were found predictors inhibiting infant vaccination. Furthermore, caregivers’ knowledge and attitudes were associated with missed opportunities for vaccination, indicating a need for strategies to enhance their understanding and combat missed opportunities in the Hohoe municipality

Identifying and addressing barriers and opportunities for bovine respiratory disease complex vaccination: a consensus paper on practical recommendations for best practise vaccination.

Many questions are raised, and challenges faced in the new era of (intranasal) bovine respiratory disease complex vaccination. An increase in vaccination rate is expected, due to its positive impact on cattle health, reduction of antimicrobial use and economic factors. However, engagement of farmers and veterinarians with regard to vaccination is often affected by limitations, resulting in the development of barriers to vaccination, but also opportunities to overcome these. The objective of the report is to provide practical recommendations and a consensus on best practises for BRDC vaccination, addressing barriers faced by veterinarians and farmers. The report combines an evidence review with expert opinions and includes discussions on different vaccination approaches, such as intranasal and systemic protocols. As result of the discussions, several barriers to BRDC vaccination were identified, including a lack of knowledge or visibility of the disease's impact, the preference for blanket antibiotic use over vaccination, resistance to change, the need for visible success, uncertainty about the best time to vaccinate, and concerns about adverse reactions and vaccine efficacy in the presence of maternal antibodies. While these barriers seem substantial, they provide opportunities for the veterinary sector. Indeed, veterinarians are encouraged to use the argumentation presented, along with local case studies and diagnostic testing to highlight the impact of disease, while conducting calf health audits, ensuring expectations are managed to achieve visible success. Overall, this consensus paper aims to provide practical recommendations and support for veterinarians and farmers to overcome barriers and increase BRDC vaccination rates in cattle.

Cervical Cancer and a History of Incarceration: Examining a Social Determinant of Health.

Females who are incarcerated are disproportionately burdened by cancer, particularly cervical cancer. We measured the odds of cervical cancer compared with nonscreenable cancers for females who were incarcerated before diagnosis. By comparing a cancer for which screening and vaccination are available with cancers for which neither are available, we aimed to assess the relationship of incarceration with diseases for which preventive care mitigates risk. We created a novel data set combining cancer data from a large cancer center with incarceration data from the state department of corrections. We then estimated the odds of cervical cancer relative to nonscreenable cancers for those with and without a history of incarceration. Females with a history of incarceration had greater odds of being diagnosed with cervical cancer compared with nonscreenable cancers (odds ratio = 7.04; 95% confidence interval [CI]: 4.4-11.0) relative to those who had not been incarcerated. Adjusting for race and age, the odds of cervical cancer remained significantly greater for those with a history of incarceration (adjusted odds ratio = 3.86; 95% CI: 2.3-6.3). Our findings support the need for expanded cervical cancer screening and vaccination opportunities for incarcerated females and increased access to preventive health care after release.

History of Human Papilloma Virus Vaccination with a Focus on Italy

The Italian National Immunization Plan (NIP) states that public health today aims at immunizing adolescents of both sexes for maximum protection against all HPV-related vaccine-preventable diseases. Nowadays, the vaccination offer to primary cohorts is reaffirmed with continued free vaccination up to at least 26 years of age for females and up to at least 18 years of age for males. The Italian NIP 2023–2025 recommends HPV vaccination for at-risk categories, including individuals with HIV, men who have sex with men (MSM), women treated for intermediate- or high-grade lesions, and travelers. Catch-up vaccination is recommended for women at least up to 26 years of age, also using the appropriate occasion of the call for the first screening for the prevention of cervical cancer as an opportunity for vaccination, and for men at least up to and including 18 years of age if they have not been previously vaccinated or have not completed the vaccination cycle. In summary, the Italian vaccination offer has been extended to additional cohorts in order to reduce the burden of HPV-related diseases and to improve vaccination coverage of the Italian population.

Trends of non-vaccination, under-vaccination and missed opportunities for vaccination (2003-2014) amongst children 0-23 months in Kenya.

Vaccines are effective and cost-effective. Non-vaccination, under-vaccination, and missed opportunities for vaccination (MOV), have contributed to incomplete vaccination coverage in Kenya. Analyzing their trends is essential for targeting interventions and improvement strategies. This study aimed to assess trends of non-vaccination, under-vaccination, and MOV among children aged 0-23 months in Kenya using data obtained from the Kenya Demographic and Health Surveys (KDHS) conducted in 2003, 2008/09, and 2014. A two-stage, multi-stage, and stratified sampling technique was used. Weighted analysis was conducted to ensure generalizability to the full population. Using the KDHS sample size estimation process, the sample size was estimated for each indicator, with varying standard error estimates, level of coverage and estimated response rates. Final sample size was 2380 (2003), 2237 (2008/09) and 7380 (2014). To determine the level of non-vaccination, under-vaccination and MOV among children aged 0-23 months, a weighted descriptive analysis was used to estimate their prevalence, with 95% confidence intervals (CI) for each year. MOV was defined using an algorithm as a binary variable. Data coding and recoding were done using Stata (version 14; College Station, TX: StataCorp LP). Trends in proportions of non-vaccination, under-vaccination and MOV were compared between 2003, 2008/09, and 2014 using the Cochrane-Armitage trend test. All results with P≤0.05 were considered statistically significant. Trends in proportion of non-vaccination among children aged 0-23 months in Kenya was 13.2%, 6.1% and 3.2% in 2003, 2008/09 and 2014, respectively (P = 0.0001). Trends in proportion of under-vaccination among children aged 0-23 months in Kenya was 54.3%, 50% and 51.3% in 2003, 2008/09 and 2014, respectively (P = 0.0109). The trends in proportion of children who experienced MOV was 22.7% in 2003, 31.9% in 2008/09 and 37.6% in 2014 (P = 0.0001). In the study duration, non-vaccination decreased by 10%, under-vaccination remained relatively stable, and MOV increased by ~15%. There is need for the Government and partners to implement initiatives that improve vaccine access and coverage, particularly in regions with low coverage rates, and to address missed opportunities for vaccination.

Pharmacist impact on pneumococcal vaccination rates through incorporation of pharmacist‐led opportunistic inpatient vaccination intervention

AbstractBackgroundPneumococcal disease continues to be a large source of morbidity and mortality despite the availability of effective prevention via immunisation and treatment measures.AimTo assess the impact of a pharmacist‐led opportunistic inpatient pneumococcal vaccination intervention on overall 13‐valent pneumococcal conjugate vaccine (13vPCV) rates in eligible hospitalised subacute patients, aged 70 years and above.MethodThis study was a pre‐ and post‐intervention study conducted across two study sites at Monash Health, a large metropolitan health service in Victoria, Australia. Phase 1 (pre‐intervention, August–October 2022) involved auditing the vaccine‐eligibility of patients on admission and subsequent administration during inpatient stay. Phase 2 (intervention phase, October–December 2022) implemented the pharmacist‐led opportunistic inpatient pneumococcal vaccine intervention. Following screening, identified vaccine‐eligible patients were recommended to the treating physician via verbal discussion and Microsoft Teams for consideration of vaccination administration in hospital. The proportion of eligible patients vaccinated was compared between the pre‐intervention and intervention groups. This project was exempt for ethics approval due to the local policy requirements that constitute research by the Monash Health Human and Research Ethics Committee (Reference no: RES‐22‐0000‐454Q). The justification for this ethics exemption was as follows: the project complies with the National Health and Medical Research Council's Ethical considerations in quality assurance and evaluation activities; auditing the percentage of vaccine‐eligible and non‐vaccinated patients did not require written consent per local requirements; and it is standard practice to obtain verbal consent, followed by documentation on electronic medical records, for inpatient vaccinations. Informed consent was obtained from participants via verbal consent after the distribution of written medical information on the 13vPCV, as well as verbal information provided by the medical team.ResultsA total of 360 patients were included in the study. Overall, 139 (77.2%) patients in the pre‐intervention and 143 (79.4%) patients in the intervention phase were eligible for vaccination (non‐vaccinated with age indication). The proportion of patients receiving inpatient 13vPCV was higher in the intervention group compared to the pre‐intervention group (43.4 vs 2.2%, p &lt; 0.001).ConclusionThe results indicate that incorporating a pharmacist‐led opportunistic inpatient pneumococcal vaccination intervention can significantly increase pneumococcal vaccination in hospital.

Suboptimal MMR Vaccination Coverages-A Constant Challenge for Measles Elimination in Romania.

Measles is targeted for elimination since 2001, with a significant reduction in cases recorded worldwide, but outbreaks occur periodically due to immunization gaps. This study analyzes the evolution of vaccination coverage rates (VCRs) in Romania, a EU country with large measles epidemics during the last two decades, including an ongoing outbreak in 2023. Vaccination against measles has been part of the National Immunization Program since 1979, initially as a single dose, and from 1994 onwards it has had two doses. The initially high national VCRs of >97% gradually declined from 2010 onward and remained constantly under 90%, with further decreases during the COVID-19 pandemic. The lowest VCRs for both vaccine doses in the last decade were recorded in 2022 and were 83.4% for the first dose and 71.4% for the second dose, with significant differences among Romania's 42 counties. Several factors contributed to this decline, including failure to attend the general practitioners' offices, increased number of children lost to follow-up due to population movements, missed vaccination opportunities due to temporary medical contraindications, a surge in vaccine hesitancy/refusal, a decreasing number of general practitioners and discontinuities in vaccine supply. The persisting suboptimal VCRs in Romania threaten the progress toward measles elimination.

Fixing a Hole: a retrospective cohort study evaluating HAV, HBV, tetanus screening, and vaccination during hospitalization in persons who use substances.

Rates of serious injection-related infections in persons who use drugs have increased. Resulting admissions are an opportunity for screening and vaccination of preventable infections such as hepatitis A virus (HAV), hepatitis B virus (HBV), and tetanus. We conducted a retrospective review of adults with documented substance use admitted for bacterial infection between July 2015 and March 2020. We evaluated HAV, HBV, and tetanus vaccination status at admission, along with screening for HAV and HBV infection and immunity. We identified the proportion of patients at risk for infection who received HAV, HBV, and tetanus vaccines during admission and patient-level factors associated with vaccination. We identified 280 patients who met our inclusion criteria. Of the 198 (70.7%) patients at risk for HAV, infectious disease providers recommended vaccination for 21 (10.6%) and 15 (7.6%) received HAV vaccine. Of the 174 (62.1%) patients at risk for HBV, infectious disease providers recommended vaccination for 32 (18.3%) and 25 (14.4%) received HBV vaccine. A large proportion of patients (31.4%, 88) had no documentation of prior tetanus vaccination, and infectious disease providers recommended tetanus vaccination for three (1.1%) and five patients (1.8%) received a tetanus booster. Infectious disease consult vaccine recommendations were statistically significantly associated with HAV or HBV vaccination prior to discharge. Over 70% of our population is at risk for one or more of these preventable infections. Efforts are needed to maximize inpatient screening and vaccination for HAV, HBV, and tetanus in patients with barriers to care.