Polio Immunization Research Articles

EVALUATION OF POLIO IMMUNIZATION COVERAGE AND ACUTE FLACCID PARALYSIS SURVEILLANCE IN EAST JAVA, INDONESIA, 2018-2022

Background: Indonesia has successfully eradicated wild poliovirus since 2005 using robust immunization and AFP surveillance programs. However, circulating vaccine-derived poliovirus type 2 has challenged these commitments, followed by the 2024 outbreak in East Java. Purpose: The study aims to analyze the polio eradication initiative by assessing polio immunization coverage and AFP surveillance in East Java. Methods: A descriptive, quantitative study design and retrospective analysis of polio immunization coverage and AFP surveillance indicators from the Provincial Health Office, East Java, from 2018–2022. The data was collected and analyzed using Excel, EpiInfo7, and Health Mapper software. Results: OPV4 coverage ranged from 89.95% to 100.76%, while IPV coverage ranged from 73.98 % to 94.18% from 2018 to 2020; the proportion of districts and cities for IPV coverage increased from 0% in 2018 to 44.74% in 2022, below the 95% WHO target. Of the 826 cases of AFP reported, 820 (99.27%) were actual AFP cases <15 years of age, with most (49.02%) being <5 years of age. Non-polio AFP rates ranged from 0.80 in 2020 to 2.59 in 2022 per 100,1000 <15 years of age, with the proportion of districts and cities slightly declining from 55.26% in 2018 to 50% in 2022. The annual mean percentage of AFP-adequate specimens is 61.15%, with the proportion of districts and cities significantly declining from 31.58% in 2018 to 10.53% in 2022, below the 80% target. Conclusion: IPV immunization coverage and AFP surveillance indicators are below the WHO-recommended targets across districts and cities in East Java.

PEMBERIAN EDUKASI TENTANG PENTINGNYA IMUNISASI LENGKAP DAN VAKSINASI POLIO

Immunization is a public health intervention that is very effective in preventing serious infectious diseases. In this context, polio vaccination plays an important role because polio can cause permanent paralysis and even death. The aim of this activity is to increase knowledge, awareness and community participation about the importance of immunization, especially polio vaccination, through providing accurate information and eliminating misinformation, as well as facilitating access to health services. Method: This service begins with preparation and includes monitoring and evaluation. Where the interventions carried out are counseling, distribution of educational materials, door-to-door visits, and mobile posyandu to the community. Results: there has been a significant increase in knowledge, awareness and positive attitudes of the community towards immunization and polio vaccination. The evaluation showed a 45% increase in knowledge and a supportive change in attitudes. Conclusion: Service activities in Bandar Kidul Village succeeded in increasing the community's knowledge and positive attitudes towards polio immunization. This activity could be a model for other regions and is recommended to be held regularly with structured material and developed for maternal and child health (KIA).

Risk Factor Analysis of Maternal Compliance in Polio Immunization for Toddlers: An Observational Study in Padang Pariaman, Indonesia

Risk Factor Analysis of Maternal Compliance in Polio Immunization for Toddlers: An Observational Study in Padang Pariaman, Indonesia

Post-Flood Challenges to Polio Eradication in Pakistan

This study aims to investigate the effect of flood on polio vaccination coverage among children aged 0-2 years in Pakistan, with a particular emphasis on the impact of floods on vaccination rates in both urban and rural areas, male and female, families of varying sizes, families with educated and uneducated heads, and the socio-economic status of households. The study utilized household-level data from the Pakistan Social and Living Standards Measurement surveys conducted between 2004-05 and 2014-15. Difference-in-Differences (DID) analysis and inverse probability of treatment weighting (IPTW) were employed, treating the flood as a quasi-natural experiment. The flood in 2010 in Pakistan disrupted polio vaccination coverage significantly; particularly in rural areas and among households led by uneducated parents. During the flood, 135 out of 1000 children aged 0-2 years were not fully vaccinated against poliovirus, and this number varied across different regions and family sizes with 171 fewer children per 1000 fully vaccinated during the flood in rural flooded areas. The adverse effects persisted for several years, with disparities observed based on parental education, gender, and household assets. Despite some recovery, the decline in polio immunization coverage remained significant in the years following the flood, especially in large families and impoverished households. Disparities based on gender, socioeconomic status, parental education, and family size were evident. Regardless of global efforts to combat polio, natural disasters like floods pose significant challenges to immunization programs, emphasizing the need for targeted interventions and improved disaster preparedness in vulnerable regions.

Polio, Eradikasi, dan Vaksinasi

Poliomyelitis (polio) is a very dangerous infectious disease. The disease is caused by polio virus which comes from the genus Enterovirus and family Picorna viridae. Polio virus enters the body through the mouth, from water or food contaminated with feces of polio sufferers. Also also due to lack of personal and environmental hygiene. Polio has no cure, the only defense is immunization. The World Health Organization (WHO) stated that in 2018 there were around 20 million children in the world who did not get complete immunization, some even did not get immunized at all. Indonesia has implemented a polio eradication program by conducting an intensive polio immunization program throughout Indonesia through an immunization development program immunization development program/PPI since 1980. The final journey of polio eradication is still challenging and difficult. Since the introduction of the poliovirus vaccine in the 1950s and early 1960s, the effectiveness of the vaccine to prevent poliomyelitis has been clearly demonstrated.

Mewujudkan Generasi Bebas Polio: Program Sub PIN Polio Di Puskesmas Mojolangu Kota Malang

The eradication of polio has become a global priority. Through the synchronized Sub-PIN Polio immunization program, the aim is to enhance human welfare and achieve a polio-free generation. The target is to reach 95% immunization coverage in the Mojolangu Health Center, Malang City. Immunization activities in the Mojolangu Health Center's area cover several schools, integrated health posts (Posyandu), and early childhood education centers (Pos PAUD), targeting children aged 0-7 years. The first round took place from January 15th to 20th, 2024. The immunization coverage has reached the target, with 95.3% of children vaccinated. This synchronized immunization effort aligns with the vision of a polio-free generation and sustainable community health achievement.

Progress Toward Poliomyelitis Eradication - Worldwide, January 2022-December 2023.

In 1988, poliomyelitis (polio) was targeted for eradication. Global efforts have led to the eradication of two of the three wild poliovirus (WPV) serotypes (types 2 and 3), with only WPV type 1 (WPV1) remaining endemic, and only in Afghanistan and Pakistan. This report describes global polio immunization, surveillance activities, and poliovirus epidemiology during January 2022-December 2023, using data current as of April 10, 2024. In 2023, Afghanistan and Pakistan identified 12 total WPV1 polio cases, compared with 22 in 2022. WPV1 transmission was detected through systematic testing for poliovirus in sewage samples (environmental surveillance) in 13 provinces in Afghanistan and Pakistan, compared with seven provinces in 2022. The number of polio cases caused by circulating vaccine-derived polioviruses (cVDPVs; circulating vaccine virus strains that have reverted to neurovirulence) decreased from 881 in 2022 to 524 in 2023; cVDPV outbreaks (defined as either a cVDPV case with evidence of circulation or at least two positive environmental surveillance isolates) occurred in 32 countries in 2023, including eight that did not experience a cVDPV outbreak in 2022. Despite reductions in paralytic polio cases from 2022, cVDPV cases and WPV1 cases (in countries with endemic transmission) were more geographically widespread in 2023. Renewed efforts to vaccinate persistently missed children in countries and territories where WPV1 transmission is endemic, strengthen routine immunization programs in countries at high risk for poliovirus transmission, and provide more effective cVDPV outbreak responses are necessary to further progress toward global polio eradication.

Inequities and trends of polio immunisation among children aged 12–23 months in Ethiopia: a multilevel analysis of Ethiopian demographic and health survey

IntroductionDespite Ethiopia’s policy intention to provide recommended vaccination services to underprivileged populations, inequity in polio immunisation persists.ObjectiveThis study examined inequity and trends in polio immunisation and determinant factors among children...

A Holistic Strategy of Mother and Child Health Care to Improve the Coverage of Routine and Polio Immunization in Pakistan: Results from a Demonstration Project.

The eradication of poliovirus and improving routine immunization (RI) coverage rates present significant challenges in Pakistan. There is a need for interventions that focus on strengthening community engagement to improve routine immunization coverage. Our primary objective is to assess the impact of an integrated strategy designed to enhance community engagement and maternal and child health immunization campaigns on immunization coverage in Pakistan's high-risk union councils of polio-endemic districts. We implemented an integrated approach for routine immunization and maternal and child health in the polio-endemic district of Pakistan. This approach involved setting up health camps and actively engaging and mobilizing the local community. An independent team conducted surveys at three key points: baseline, midline, and endline, to evaluate immunization coverage among children under the age of five. The primary outcome measures for the study were coverage of OPV, IPV, and changes in the proportion of unvaccinated and fully vaccinated children. To select clusters and eligible households in each cluster, we utilized a 30 × 15 cluster sampling technique. Multivariable associations between socio-demographic factors and changes in the proportion of fully vaccinated children at the UC level were assessed using hierarchical linear regression models. A total of 256,946 children under the age of five (122,950 at baseline and 133,996 at endline) were enrolled in the study. By the endline, full immunization coverage had increased to 60% or more in all three study areas compared to the baseline. Additionally, there was a significant increase in the coverage of both OPV and IPV across all three provinces at the endline. The full immunization rates were assessed on three levels of the framework: the distal, intermediate (access and environment), and proximal level (camp attendance and effectiveness). At the distal level, on multivariate analysis, family size was found to be a significant predictor of change in immunity within the families (β = 0.68; p ≤ 0.0001). At the intermediate level, the likelihood of full immunization decreased with the decrease in knowledge about vaccination (β = -0.38; p = 0.002), knowledge about polio vaccine (β = -0.25; p = 0.011), and knowledge about IPV (β = -0.06; p = 0.546). Perceived obstacles to vaccination were fear of adverse events (β = -0.4; p ≤ 0.0001) and lack of education (β = 0.23; p = 0.031), which were found to be significant in bivariate and multivariate analyses. At the proximal level, community mobilization (β = 0.26; p = 0.008) and attendance at health camp (β = 0.21; p ≤ 0.0001) were found to enhance full immunization coverage. On the other hand, the most prominent reason for not attending health camp included no need to attend the health camp as the child was not ill (β = -0.13; p = 0.008). This study found that community mobilization and attendance at health camps significantly enhanced full immunization coverage. The findings highlight the importance of community engagement and targeted interventions in improving immunization coverage and addressing barriers to healthcare seeking.

RELATED FACTORS TO G IV ING OF IPV (INACTIVA TED POLIO VACCINE) P OLIO IMMUNIZATION TO BABY IN THE WORKING AREA OF THE PAUH HEALTH CENT ER, CENTER OF PARIAMAN D ISTRICT, PARIAMAN CI TY

In the Indonesian context, the IPV polio immunization program has been introduced since 2015 as part of the national immunization program. However, even though this program has been running for several years, there are still challenges in increasing immunization coverage in infants. The urgency of this research, with the status of Indonesia being a Polio Outbreak (Extraordinary Incident) of Polio, it is important to pay attention to these factors in developing an immunization program and determine an effective strategy to increase immunization coverage. This research can also provide important information for health care providers, including doctors and nurses, to understand parents' perceptions of IPV polio immunization and how they can increase parental support and involvement in immunizing their children. This study aims to analyze the factors that influence parents' decisions to provide polio immunization using IPV to their children, which this study has not specifically investigated. The factors that will be analyzed in this study include knowledge, attitudes, motivation, accessibility of health services, availability of health services, role of health workers, family support, socio-culture. This type of research is analytic research with an observational study design, a cross sectional study approach. Data will be analyzed univariately, bivariately, and up to multivariate analysis. The results of this study can provide important information for the government and health institutions in developing an effective and efficient polio immunization program and increasing coverage in infants and toddlers. This research can also provide insight into the factors that influence parental non-adherence to vaccine side effects or their belief in alternative treatments that influence their decision not to give their children IPV polio immunization. In conclusion, this research is very important in increasing the coverage of IPV polio immunization in children under five and preventing the spread of polio in Indonesia.

A circulating vaccine-derived poliovirus type 2 outbreak in a chronic conflict setting: a descriptive epidemiological study in South Sudan – 2020 to 2021

BackgroundIn this study, we describe the epidemiological profile of an outbreak of the circulating Vaccine Derived Polio Virus type 2 in South Sudan from 2020 to 2021.MethodWe conducted a retrospective descriptive epidemiological study using data from the national polio/AFP surveillance database, the outbreak investigation reports, and the vaccination coverage survey databases stored at the national level.ResultsBetween September 2020 and April 2021, 59 cases of the circulating virus were confirmed in the country, with 50 cases in 2020 and 9 cases in 2021. More cases were males (56%) under five (93%). The median age of the cases was 23.4 ± 11.9 months, ranging from 1 to 84 months. All states, with 28 out of the 80 counties, reported at least one case. Most of the cases (44, 75%) were reported from five states, namely Warrap (31%), Western Bahr el Ghazal (12%), Unity (12%), Central Equatoria (10%), and Jonglei (10%). Four counties accounted for 45.8% of the cases; these are Gogrial West with 12 (20%), Jur River with 5 (8.5%), Tonj North with 5 (8.5%), and Juba with 5 (8.5%) cases.The immunization history of the confirmed cases indicated that 14 (24%) of the affected children had never received any doses of oral polio or injectable vaccines either from routine or during supplemental immunization before the onset of paralysis, 17 (28.8%) had received 1 to 2 doses, while 28 (47.5%) had received 3 or more doses (Fig. 4). Two immunization campaigns and a mop-up were conducted with monovalent Oral Polio Vaccine type 2 in response to the outbreak, with administrative coverage of 91.1%, 99.1%, and 97% for the first, second, and mop-up rounds, respectively.ConclusionThe emergence of the circulating vaccine-derived poliovirus outbreak in South Sudan was due to low population immunity, highlighting the need to improve the country’s routine and polio immunization campaign coverage.

Development of a Consolidated Health Facility Masterlist Using Data From Polio Electronic Surveillance in the World Health Organization African Region.

Geospatial data reporting from surveillance and immunization efforts is a key aspect of the World Health Organization (WHO) Global Polio Eradication Initiative in Africa. These activities are coordinated through the WHO Regional Office for Africa Geographic Information Systems Centre. To ensure the accuracy of field-collected data, the WHO Regional Office for Africa Geographic Information Systems Centre has developed mobile phone apps such as electronic surveillance (eSURV) and integrated supportive supervision (ISS) geospatial data collection programs. While eSURV and ISS have played a vital role in efforts to eradicate polio and control other communicable diseases in Africa, disease surveillance efforts have been hampered by incomplete and inaccurate listings of health care sites throughout the continent. To address this shortcoming, data compiled from eSURV and ISS are being used to develop, update, and validate a Health Facility master list for the WHO African region that contains comprehensive listings of the names, locations, and types of health facilities in each member state. The WHO and Ministry of Health field officers are responsible for documenting and transmitting the relevant geospatial location information regarding health facilities and traditional medicine sites using the eSURV and ISS form; this information is then used to update the Health Facility master list and is also made available to national ministries of health to update their respective health facility lists. This consolidation of health facility information into a single registry is expected to improve disease surveillance and facilitate epidemiologic research for the Global Polio Eradication Initiative, as well as aid public health efforts directed at other diseases across the African continent. This review examines active surveillance using eSURV at the district, country, and regional levels, highlighting its role in supporting polio surveillance and immunization efforts, as well as its potential to serve as a fundamental basis for broader public health initiatives and research throughout Africa.

Combating Polio Vaccine Hesitancy: An Evaluation of Mediated Polio Eradication Campaigns in Pakistan

Health campaign initiatives are especially tailored to the needs of their target audience and encourage vaccination adoption for polio eradication. Vaccination resistance, however, remains a serious barrier in Pakistan. The content analysis method was used to examine message appeals and message characteristics used in Pakistan's Polio National Immunization Campaigns from 2020 to 2022. Polio advertisements were obtained from the Pakistan Polio Eradication Program's internet archives. Advertisements range in duration from 40 to 60 seconds on average. The quantitative results provided to a deeper understanding of the message characteristics (credibility of message presenters, appeals, style, slogan, language) used in anti-polio advertisements broadcasted via cable and television channels during the Polio National Immunization Campaigns. It was evident that attempts were made to effectively engage the target audience via the employment of 31% knowledgeable speakers, a range of message appeals 34%, and a diversity of communication styles 72%. The necessity for ongoing evaluation and improvement of campaign message techniques was highlighted by variations in the use of slogans and regional languages. Keywords: Mediated Polio Immunization Campaigns, Message Appeals, Polio Vaccination, Polio vaccine hesitancy

The Last Mile-Community Engagement and Conditional Incentives to Accelerate Polio Eradication in Pakistan: Study Protocol for a Quasi-Experimental Trial.

Poliomyelitis is a condition of great concern and is endemic in only two countries of the world: Pakistan and Afghanistan. Community mobilization plays a vital role in raising awareness and can help reduce polio vaccine refusals. The objective of this study will be to decrease polio vaccine refusals and zero-dose vaccines by motivating behavior change through the provision of conditional-collective-community-based incentives (C3Is) based on a reduction in polio vaccine refusals. The project will adopt a pretest/post-test quasi-experimental design with two intervention high-risk union councils (HRUCs) and two control union councils (UCs) of peri-urban (Karachi) and rural (Bannu) settings in Pakistan. A participatory community engagement and demand creation strategy with trust-building community mobilization with C3Is, to reduce vaccine refusals and improve polio immunization coverage in two HRUCs, will be used. These UCs will be divided into clusters based on the polio program framework and community groups will be formed in each cluster. These community groups will carry out awareness activities and will be given serial targets to reduce vaccine refusals and those who qualify will be provided C3Is. The project intends to create a replicable model that the government can integrate within health systems for long-term sustainability until the goal of eradication of poliovirus is achieved. The evaluation will be carried out by an independent data collection and analysis team at baseline and endline (after 12 months of intervention). The trial is registered with linicalTrials.gov with number NCT05721274.

Health Economic Analysis of Antiviral Drugs in the Global Polio Eradication Endgame.

Polio antiviral drugs (PAVDs) may provide a critical tool in the eradication endgame by stopping poliovirus infections in immunodeficient individuals who may not clear the virus without therapeutic intervention. Although prolonged/chronic poliovirus excreters are rare, they represent a source of poliovirus reintroduction into the general population. Prior studies that assumed the successful cessation of all oral poliovirus vaccine (OPV) use estimated the potential upper bound of the incremental net benefits (INBs) of resource investments in research and development of PAVDs. However, delays in polio eradication, OPV cessation, and the development of PAVDs necessitate an updated economic analysis to reevaluate the costs and benefits of further investments in PAVDs. Using a global integrated model of polio transmission, immunity, vaccine dynamics, risks, and economics, we explore the risks of reintroduction of polio transmission due to immunodeficiency-related vaccine-derived poliovirus (iVDPV) excreters and reevaluate the upper bound of the INBs of PAVDs. Under the current conditions, for which the use of OPV will likely continue for the foreseeable future, even with successful eradication of type 1 wild poliovirus by the end of 2023 and continued use of Sabin OPV for outbreak response, we estimate an upper bound INB of 60 million US$2019. With >100 million US$2019 already invested in PAVD development and with the introduction of novel OPVs that are less likely to revert to neurovirulence, our analysis suggests the expected INBs of PAVDs would not offset their costs. While PAVDs could play an important role in the polio endgame, their expected economic benefits drop with ongoing OPV use and poliovirus transmissions. However, stakeholders may pursue the development of PAVDs as a desired product regardless of their economic benefits.HighlightsWhile polio antiviral drugs could play an important role in the polio endgame, their expected economic benefits continue to drop with delays in polio eradication and the continued use of oral poliovirus vaccines.The incremental net benefits of investments in polio antiviral drug development and screening for immunodeficiency-related circulating polioviruses are small.Limited global resources are better spent on increasing global population immunity to polioviruses to stop and prevent poliovirus transmission.

Inequity of maternal-child health services in ASEAN member states from 1993 to 2021

IntroductionInequity in maternal-child health services is a challenge to global health as it hinders the achievement of Sustainable Development Goals (SDGs) and Universal Health Coverage. Though the Association of Southeast Asian Nations (ASEAN) has made remarkable achievements in maternal-child health, there remain gaps in reaching global goals. This study aimed to compare and investigate the inequity in maternal-child health (MCH) services in ASEAN member states to help guide policy decisions to improve equitable health services in the SDG era and beyond.MethodsUsing the WHO Health Inequality Monitor, we identified inequity summary measures for five MCH services in ASEAN member states from 1993 to 2021: antenatal care, births attended by skilled health personnel, diphtheria, tetanus and pertussis (DTP3) immunization, measles immunization, and polio immunization. We divided the analysis dimension of inequity into urban–rural inequity, economic status inequity, and sub-regional inequity. Trends of absolute and relative inequity in every dimension of MCH services in ASEAN member states were examined with the principal component analysis (PCA).ResultsThe mean coverages of MCH services are 98.80% (Thailand), 86.72% (Cambodia), 84.54% (Viet Nam), 78.52 (Indonesia), 76.94% (Timor-Leste), 72.40% (Lao PDR), 68.10% (Philippines) and 48.52% (Myanmar) in 2021. Thailand have the lowest MCH services absolute inequity indexes of -1.945, followed by Vietnam (-1.449). Lao PDR and Myanmar have relatively higher MCH services absolute inequity indexes of 0.852 and 0.054 respectively. The service in Cambodia, Indonesia, and the Philippines is pro-specific regions (with subnational region absolute inequity indexes of -0.02, 0.01, and 1.01 respectively). The service in Myanmar is pro-rich (with economic status absolute inequity index of 0.43). The service in Lao PDR and Timor-Leste is pro-urban areas, pro-rich, and pro-specific regions.ConclusionThe inequity of MCH services in ASEAN persists but is in a declining trend. Thailand and Vietnam have performed well in ensuring MCH services equity, while Laos and Myanmar are still facing serious inequity dilemmas. The progress of MCH service equity in Myanmar, Cambodia, the Philippines, and Indonesia is uneven. It is acceptable to learn from the successful experiences of Thailand and Vietnam to improve the equities in other ASEAN countries. Policies should be developed according to the specific types of MCH inequity in member states to improve equity levels.

Exploring Knowledge and Perceptions of Polio Disease and Its Immunization in Polio High-Risk Areas of Pakistan.

Pakistan is one of the few countries where poliovirus transmission still persists, despite intensive efforts to eradicate the disease. Adequate vaccination coverage is essential to achieve polio eradication, but misconceptions about polio vaccines have hindered vaccination efforts. To address this issue, we conducted a mixed-methods study to explore knowledge and perceptions regarding polio disease and immunization in high-risk areas of Pakistan. We collected quantitative data from 3780, 1258, and 2100 households in Karachi, Bajaur, and Pishin, respectively, and supplemented this with qualitative data from focus group discussions and in-depth interviews. Our findings reveal a high level of awareness about polio and its immunization; however, misperceptions about the polio vaccine persist, leading to refusal for both polio vaccines and routine immunizations. Our study provides up-to-date data on knowledge and perceptions of polio and its immunization and identifies critical gaps. These findings can inform the development of future strategies and innovative approaches to improve the success of the polio program in Pakistan.

Effect of Health Promotion on Immunization on Increasing Maternal Participation and Basic Immunization Coverage in The Village Tanjung Laong Working Area of Technical Implementation Unit of Muara Pahu Public Health Center

Introduction: Complete basic immunization is immunization given to children before the age of 1 year which consists of HB 0 immunization, BCG immunization, DPT-HB-HIB immunization, polio immunization, IPV immunization and measles immunization. The benefit of immunization is to provide immunity to infants in order to prevent illness and death of infants and children caused by frequently infectious diseases. Objective: This study aims to determine the effect of health promotion on immunization on increasing maternal participation and basic immunization coverage in tanjung Laong village, the working area of the Technical Implementation Unit of Muara Pahu Public Health Center Methods: The research design in this study was a quasi-experimental research design with one group pretest-posttest design. The study was carried out in March 2022. The population in this study were allmothers who had infants and toddlers aged 1-12 mounth in Tanjung Laong Village totaling 19 peolple. Results and Discussion: The effect of health promotion on immunization on increasing maternal participation was obtained pValue = 0.003 smaller than 0.05 and the effect of health promotion on immunization on basic immunization coverage obtained pValue = 0.001 smaller than 0.05. Conclusion: There is an effect of health promotion on immunization on increasing maternal participation and basic immunization coverage in Tanjung laong Village, the working area of Technical Implementation Unit of Muara Pahu Public Health Center

Halting vaccine-derived poliovirus circulation: the novel type 2 oral vaccine might not be enough

Halting vaccine-derived poliovirus circulation: the novel type 2 oral vaccine might not be enough

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

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