Post-vaccination Surveys Research Articles

Outcomes of a Short-Duration, Large-Scale Canine Rabies Vaccination Campaign in Central Cambodia.

WHO and WOAH advocate for annual high-coverage canine rabies vaccination campaigns as the most sustainable approach to eliminate the risk of dog rabies transmission to humans. It is estimated that Cambodia has one of the highest human rabies deaths per capita of any country (5.8 human deaths per 100,000 people), highlighting the urgent need to implement an effective canine rabies vaccination program. To this end, a coalition of government and non-government organizations conducted a pioneering short-duration dog rabies vaccination campaign over 10 days across Phnom Penh and Kandal Provinces in May 2023. Over 10 working days, 120 vaccination teams, each consisting of two vaccinators and one tuk-tuk driver, traveled door-to-door to deliver parenteral rabies vaccines to all dogs that could be held by the teams or members of the community. Spatial team management and data collection were conducted through the WVS Data Collection Application. A total of 74,983 dogs were vaccinated, giving a mean vaccination rate of 62.5 dogs per team per day. An additional 2145 cats were vaccinated. Of all dogs encountered by the teams, 84.0% could be vaccinated, with 99.1% of those being identified as owned. Post-vaccination surveys of 4356 households estimated a mean vaccination coverage of 70.7% in owned dogs across the districts of Phnom Penh Province. Short-duration, large-scale canine rabies vaccination campaigns can achieve high vaccination coverage using a door-to-door approach in urban centers of Cambodia. Data gathered through the campaign yielded insights to support the refinement and planning of a wider rabies control strategy and is anticipated to drive further support for subsequent campaigns in Cambodia.

Applying causal inference and Bayesian statistics to understanding vaccine safety signals using a simulation study

Community perception of vaccine safety influences vaccine uptake. Our objective was to assess current vaccine safety monitoring by examining factors that may influence the availability of post-vaccination survey data, and thereby the specificity and sensitivity of existing signal detection methods. We used causal directed acyclic graphs (DAGs) and a Bayesian posterior predictive analysis (PPA) signal detection method to understand biological and behavioural factors which may influence signal detection. The DAGs informed the data simulated for scenarios in which these factors were varied. The influence of biological factors such as severity of adverse reactions and behavioural factors such as healthcare-seeking behaviour upon survey participation was found to drive signal detection. Where there was a low prevalence of moderate to severe reactions, false signals were detected when there was a strong influence of reaction severity on both survey participation and seeking medical attention. These findings provide implications for future vaccine safety monitoring.

COVID-19 vaccination hesitance and adverse effects among US adults: a longitudinal cohort study.

Although Coronavirus disease 2019 (COVID-19) vaccination is critical to control its spread, vaccine hesitancy varies significantly among the United States population; moreover, some vaccine recipients experienced various adverse effects. We aim to assess the impact of COVID-19 vaccine hesitancy in a university-affiliated community, the factors affecting participants' decisions, and their adverse effects. A pre-vaccination online Institutional Review Board IRB-approved survey was emailed in Nov/Dec 2020, 2 months before the implementation of state-policy protocols for COVID-19 vaccination. A post-vaccination survey was emailed in May/June 2021, two months after protocol execution. A third follow-up survey was sent in Nov/Dec 2021, and a fourth was sent in June/July 2022. The study population included three groups of adult participants: university students, faculty, and staff-(MS), university health system patients-(MP), and Cancer Center patients-(MCP). The study was designed as a longitudinal cohort study. Statistical analyses were performed using SPSS. With a combined response rate of 26% (40,578/157,292) among the four surveys, 15,361 participants completed the first survey (MS = 4,983, MP = 9,551, and MCP = 827). 2/3 of participants (63.5%) were willing to get vaccinated, with a significant difference in acceptance among groups, MS:56.6%, MP:66.2%, and MCP:71.6% (p < 0.05). Vaccine acceptance rates reached 89% in the second survey after the vaccine's approval, with a lower acceptance rate of MS:84.6% than with MP:90.74% and MCP:92.47% participants (p < 0.05). Safety and effectiveness concerns were the main factors affecting participants' decisions in all the first three surveys; however, participants reported these concerns decreased between pre-vaccination, post-vaccination, and follow-up surveys with 87%, 56%, and 46%, respectively(p < 0.05). More than two-thirds of the participants (70%) reported having either minor/moderate symptoms (61.6%) or major symptoms (8.6%) after getting some of the vaccine doses (p < 0.05). The hesitance of COVID-19 vaccination was associated with concerns regarding its safety and efficacy. Vaccine acceptance rose higher than expected after protocol execution, likely due to continuous education, whereas safety and efficacy remain factors hindering vaccine acceptance. Continuous education focusing on safety and efficacy of the vaccine can reduce vaccine hesitancy and raise the rates of vaccination.

Development, Implementation, and Evaluation of Three Outreach Events to Improve COVID-19 Vaccine Uptake Among Racial and Ethnic Minority Communities in Houston, Texas, 2022.

Lack of access to timely, accurate, and linguistically appropriate COVID-19 information has complicated the dissemination of evidence-based information and contributed to vaccine hesitancy among racial and ethnic minority groups in the United States. We developed community events that provided outreach, education, and access to COVID-19 vaccination to overcome vaccine hesitancy in these communities. Using spatial analysis techniques, we identified 3 communities with low vaccine uptake in Houston, Texas, in fall 2021; engaged 20 stakeholders from these communities via 4 focus groups to understand barriers to vaccination; and developed and implemented 3 COVID-19 vaccine education and outreach events tailored to the needs of these communities in January-March 2022. We used program evaluation surveys to assess attendee characteristics and satisfaction with the events. Vaccinated attendees also completed surveys on what motivated them to get vaccinated. Two communities were predominantly Hispanic, and the third had an equal number of Black and Hispanic residents. Based on community stakeholder input, the study team organized 2 health fairs and 1 community festival featuring dialogue-based COVID-19 vaccine engagement in January and March 2022. Across the 3 events, a total of 865 attendees received COVID-19 education and 205 (24.0%) attendees received a COVID-19 vaccine or booster. Of 90 attendees who completed program evaluation surveys, 81 (90%) rated the outreach event as good or excellent. Of 145 attendees who completed postvaccination surveys, 132 (91%) endorsed ≥1 key program feature as motivating them to either get vaccinated or vaccinate their child that day. Community outreach events are important strategies for disseminating information, building trust, and facilitating COVID-19 vaccine uptake.

Evaluating serological tests for foot-and-mouth disease while accounting for different serotypes and uncertain vaccination status

Controlling foot-and-mouth disease (FMD) by vaccination requires adequate population coverage and high vaccine efficacy under field conditions. To assure veterinary services that animals have acquired sufficient immunity, strategic post-vaccination surveys can be conducted to monitor the coverage and performance of the vaccine. Correct interpretation of these serological data and an ability to derive exact prevalence estimates of antibody responses requires an awareness of the performance of serological tests. Here, we used Bayesian latent class analysis to evaluate the diagnostic sensitivity and specificity of four tests. A non-structural protein (NSP) ELISA determines vaccine independent antibodies from environmental exposure to FMD virus (FMDV), and three assays measuring total antibodies derived from vaccine antigen or environmental exposure to two serotypes (A, O): the virus neutralisation test (VNT), a solid phase competitive ELISA (SPCE), and a liquid phase blocking ELISA (LPBE). Sera (n=461) were collected by a strategic post-vaccination monitoring survey in two provinces of Southern Lao People's Democratic Republic (PDR) after a vaccination campaign in early 2017. Not all samples were tested by every assay and each serotype: VNT tested for serotype A and O, whereas SPCE and LPBE tested for serotype O, and only NSP-negative samples were tested by VNT, with 90 of them not tested (missing by study design). These data challenges required informed priors (based on expert opinion) for mitigating possible lack of model identifiability. The vaccination status of each animal, its environmental exposure to FMDV, and the indicator of successful vaccination were treated as latent (unobserved) variables. Posterior median for sensitivity and specificity of all tests were in the range of 92-99 %, except for the sensitivity of NSP (∼66%) and the specificity of LPBE (∼71 %). There was strong evidence that SPCE outperformed LPBE. In addition, the proportion of animals recorded as having been vaccinated that showed a serological immune response was estimated to be in the range of 67-86 %. The Bayesian latent class modelling framework can easily and appropriately impute missing data. It is important to use field study data as diagnostic tests are likely to perform differently on field survey samples compared to samples obtained under controlled conditions.

Sex differences in B cell frequencies and antibody responses following influenza vaccination in healthcare workers during the 2019–2020 season

Abstract Annual influenza vaccination for healthcare workers (HCWs) is required at Johns Hopkins to reduce influenza spread in healthcare facilities. We conducted a clinical study to evaluate sex differences in virus-specific antibody-producing B cells (i.e., plasmablasts) following receipt of the seasonal influenza vaccine in a highly vaccinated population of healthcare workers. To understand sex differences in immune responses to the influenza vaccine in the HCWs, 83 participants consented to blood draws at baseline and 75 participants returned for the 7- and 28-days post-vaccination survey and blood draw. Participants received their annual quadrivalent influenza vaccine (QIV). Influenza A specific plasmablasts were quantified at baseline and day 7 post-vaccination. Males had a significantly greater percentage of influenza-specific plasmablasts than females after vaccination (p&amp;lt;0.0003) Plasma collected at baseline and at day 28 post-vaccination was used to measure neutralizing antibody (nAb) titers against H1N1 and H3N2 vaccine viruses. Neutralizing antibody responses against either the H1N1 and H3N2 viruses increase after vaccination to the same degree in both males and females. The proportion of plasmablasts at day 7 was significantly associated with the vaccine-induced fold rise in nAb. This relationship differed by sex, whereby for a given proportion of plasmablasts, females tended to mount a greater fold-rise in nAb than males. These data suggest that despite having potentially fewer plasmablasts after vaccination, females mount an antiviral antibody response to the influenza vaccine viruses equivalent to males. Identification of transcriptional differences in plasmablasts from male and female HCWs is ongoing.

Knowledge, Attitudes, Perceptions and Vaccination Acceptance/Hesitancy among the Community Pharmacists of Palermo's Province, Italy: From Influenza to COVID-19.

In Italy, following the start of the SARS-CoV-2 vaccination campaign, community pharmacies (CPs) were recruited on a voluntary basis in order to administer COVID-19 vaccines as part of their activities. The aim of the present study was to investigate the knowledge, attitudes, and practices regarding SARS-CoV-2 infection prevention, and vaccine acceptance/hesitancy towards COVID-19 and influenza vaccinations among the community pharmacists operating in the Palermo Province. A cross-sectional study was conducted, with two different questionnaires administered before and after the conduction of the vaccination campaign against SARS-CoV-2 at the COVID-19 vaccination center of the Palermo University Hospital (PUH). The baseline survey showed that 64% of community pharmacists (CPs) declared that they planned to vaccinate against SARS-CoV-2, and 58% were vaccinated against influenza during the 2020/2021 season. Factors significantly associated with willingness to receive the COVID-19 vaccination were confidence in vaccines (adjOR 1.76; CI 1.11–2.80), fear of contracting SARS-CoV-2 infection (adjOR 1.50; CI 1.06–2.11), considering COVID-19 vaccination to be the best strategy to counteract SARS-CoV-2 (adjOR 1.79; CI 1.39–2.29), and adherence to influenza vaccination during the 2020/2021 season (adjOR 3.25; CI 2.23–4.25). The adherence among CPs of the Palermo Province to COVID-19 vaccination was 96.5%. From the post-vaccination survey, the main reasons for changing opinions on vaccination adherence were the introduction of mandatory vaccinations, fear of contracting COVID-19, and limitations on work activities in the case of vaccine refusal. The achievement of very high COVID-19 vaccination coverage rates among healthcare professionals (HCPs) in the present study was mainly due to the mandatory vaccination policies; nevertheless, a willingness for COVID-19 vaccination was relatively high among pharmacists before the beginning of the vaccination campaign. HCPs and CPs should receive training on vaccination, which is recommended in the national immunization plan and is also suggested by the respondents in our study, in order to routinely re-evaluate their own vaccination profiles, as well as those of their patients.

Sharing the Load by One Health: Integrating Canine Rabies Vaccination With Bovine Foot-and-Mouth Vaccination Program and Community Public Health Services in Rural Nilgiris District, Tamil Nadu, India.

India carries the largest national burden for rabies globally. Coordinating large-scale canine rabies elimination programs is challenging, particularly in rural areas, where the majority of human rabies deaths occur. This study evaluated the feasibility of combining canine rabies vaccination with pre-existing animal-health interventions or public health programs in a rural area of India. Canine rabies vaccination teams collaborated with a bi-annual bovine foot-and-mouth vaccination program coordinated by the Animal Husbandry Department (AH-collaboration) and with a village health program by the Public Health Department (PH-collaboration) in Nilgiris, Tamil Nadu, to vaccinate dogs during the implementation of these government-led health initiatives. A total of 251 dogs were vaccinated over 7 days during the AH-collaboration, and 1083 dogs were vaccinated over 15 days during the PH-collaboration. The AH-collaboration achieved a vaccination coverage of 76% based on same-time sighting survey, and 58% based on post-vaccination survey. The PH-collaboration achieved vaccination coverage of 79% based on the same-time survey and 83% based on the post-vaccination survey. The integration of mass dog vaccination into existing government sector initiatives may facilitate the scaling up of canine rabies vaccination campaigns.

Post-vaccination survey for monitoring the side effects associated with COVID-19 vaccines among healthcare professionals of Jazan province, Saudi Arabia.

Objectives:To identify the self-reported vaccine-related side effects among healthcare professionals (HCPs) in the Jazan province, Saudi Arabia, and determine the associated socio-demographic factors. With the recent second and third waves of coronavirus disease -19 (COVID-19) infections worldwide, the race is not only to encourage but also to achieve mass vaccination.Methods:A total of 397 HCPs from across Jazan province participated in an anonymous online cross-sectional survey conducted for a period of 45 days (March 30, 2021 to May 13, 2021) in Jazan province, Saudi Arabia. Data was collected using a validated 22-items self-report survey.Results:For both COVID-19 vaccines, majority of reports were related to flu-like symptoms including fever, chills, headache, fatigue, tiredness, and myalgia. Statistically significant associations were observed between the severity of side effects and gender (χ2=73.32; p<0.001), type of vaccine (χ2=112.08; p<0.001), and presence of known allergies (χ2=99.69; p<0.001). Female HCPs were more likely to report any side effects compared with male HCPs (adjusted odds ratio [AOR]: 3.72; p<0.001). Furthermore, HCPs with known allergies were more likely to report any side effects than their counterparts with unknown allergies (AOR: 16.29; p<0.001).Conclusion:The findings of the present study would help in designing educational programs aimed at combating the misconstrued fear of vaccination and highlighting the urgent need of getting vaccinated. This study also helps in the identification of factors affecting the presence and severity of side effects.

Promoting coronavirus disease 2019 (COVID-19) vaccination among healthcare personnel: A multifaceted intervention at a tertiary-care center in Japan.

The coronavirus disease 2019 (COVID-19) vaccine may hold the key to ending the pandemic, but vaccine hesitancy is hindering the vaccination of healthcare personnel (HCP). We examined their perceptions of the COVID-19 vaccine and implemented an intervention to increase vaccination uptake. Before-and-after trial. Healthcare personnel at a 790-bed tertiary-care center in Tokyo, Japan. A prevaccination questionnaire was administered to HCP to examine their perceptions of the COVID-19 vaccine. A multifaceted intervention was then implemented involving (1) distribution of informational leaflets to all HCP, (2) hospital-wide announcements encouraging vaccination, (3) a mandatory lecture, (4) an educational session about the vaccine for pregnant or breastfeeding HCP, and (5) allergy testing for HCP at risk of allergic reactions to the vaccine. A postvaccination survey was also performed. Of 1,575 HCP eligible for enrollment, 1,224 (77.7%) responded to the questionnaire, 533 (43.5%) expressed willingness to be vaccinated, 593 (48.4%) were uncertain, and 98 (8.0%) expressed unwillingness to be vaccinated. The latter 2 groups were concerned about the vaccine's safety rather than its efficacy. After the intervention, the overall vaccination rate reached 89.7% (1,413 of 1,575), and 88.9% (614 of 691) of the prevaccination survey respondents answered "unwilling" to or "unsure" about eventually receiving a vaccination. In the postvaccination questionnaire, factors contributing to increased COVID-19 vaccination included information and endorsement of vaccination at the medical center (274 of 1,037, 26.4%). This multifaceted intervention increased COVID-19 vaccinations among HCP at a Japanese hospital. Frequent support and provision of information were crucial for increasing the vaccination rate and may be applicable to the general population as well.

Field challenges to measles elimination in the Democratic Republic of the Congo

BackgroundDuring a measles epidemic, the Ministry of Public Health (MOH) of the Democratic Republic of the Congo conducted supplementary immunization activities (2016-SIA) from August 28-September 3, 2016 throughout Maniema Province. From October 29-November 4, 2016, Médecins Sans Frontières and the MOH conducted a reactive measles vaccination campaign (2016-RVC) targeting children six months to 14 years old in seven health areas with heavy ongoing transmission despite inclusion in the 2016-SIA, and a post-vaccination survey. We report the measles vaccine coverage (VC) and effectiveness (VE) of the 2016-SIA and VC of the 2016-RVC. MethodsA cross-sectional VC cluster survey stratified by semi-urban/rural health area and age was conducted. A retrospective cohort analysis of measles reported by the parent/guardian allowed calculation of the cumulative measles incidence according to vaccination status after the 2016-SIA for an estimation of crude and adjusted VE. ResultsIn November 2016, 1145 children (6–59 months old) in the semi-urban and 1158 in the rural areas were surveyed. Post-2016-SIA VC (documentation/declaration) was 81.6% (95%CI: 76.5–85.7) in the semi-urban and 91.0% (95%CI: 84.9–94.7) in the rural areas. The reported measles incidence in October among children less than 5 years old was 5.0% for 2016-SIA-vaccinated and 11.2% for 2016-SIA-non-vaccinated in the semi-urban area, and 0.7% for 2016-SIA-vaccinated and 4.0% for 2016-SIA-non-vaccinated in the rural area. Post-2016-SIA VE (adjusted for age, sex) was 53.9% (95%CI: 2.9–78.8) in the semi-urban and 78.7% (95%CI: 0–97.1) in the rural areas. Post 2016-RVC VC (documentation/declaration) was 99.1% (95%CI: 98.2–99.6) in the semi-urban and 98.8% (95%CI: 96.5–99.6) in the rural areas. ConclusionsAlthough our VE estimates could be underestimated due to misclassification of measles status, the VC and VE point estimates of the 2016-SIA in the semi-urban area appear suboptimal, and in combination, could not limit the epidemic. Further research is needed on vaccination strategies adapted to urban contexts.

Lessons for rabies control and elimination programmes: a decade of One Health experience from Bali, Indonesia.

Since the emergence of rabies on Bali, Indonesia, in 2008, the Indonesian Government and other stakeholders have implemented disease control and prevention activities with the aim of re-securing Bali's freedom from dog-mediated rabies. The authors report on the lessons learned during these efforts, and their applicability to other regions where canine rabies is endemic, as well as to rabies-free populations that are at risk from incursions. To eliminate rabies from Bali will require time and commitment, as well as a combination of approaches employing the principle of One Health. Efforts should be directed towards well-coordinated, highcoverage, annual dog vaccination campaigns using high-quality vaccines, and enhanced surveillance focused on investigations of biting animals. Bali, an island, is an ideal target for achieving freedom from rabies, but the logistics of vaccinating its very large, free-roaming dog population are challenging. Lessons can be drawn from Bali for other large and dense dog populations, where dog management and rabies control appear difficult. Well-trained teams with nets can rapidly catch and vaccinate large numbers of dogs where central-point vaccination is insufficient, and post vaccination surveys of collared dogs can be used to evaluate coverage and target supplementary vaccination. However, careful planning is required to ensure that all communities are reached during such campaigns and that sufficient vaccine is available over the following years. Effective communication strategies are needed to coordinate intersectoral activities, and to keep communities engaged, particularly during the 'end game', when the risk of rabies appears only minimal. An effective One Health approach to eliminate rabies requires long-term planning, multisectoral communication and coordination, and sustained effort, using tried and tested methods.

Using Mapping, Global Positioning System (GPS) and Smart Phone Technology in Rabies Control Program in Kotagiri, Nilgiris District, India

In this study, we utilized a catch-vaccinate-release approach for dogs in a canine rabies vaccination program in Kotagiri municipality, India. Following vaccination, surveys on dog population and their vaccination status was undertaken. A bespoke smartphone ‘Mission Rabies’ application was developed to facilitate data entry and team management. This global positioning system (GPS) enabled application captured the location of all vaccinated dogs and dogs sighted on post-vaccination surveys. In areas where coverage was below 70%, catching teams were re-deployed to vaccinate additional dogs followed by repeat survey. Out of 248 dogs captured, only 210 dogs were vaccinated because of the previous vaccination history within a year, and refusal of owner due to their misconceptions. In survey, 147 dogs were sighted of which 77 were seen marked with paints indicating a vaccination coverage of 52.4%. The total estimated dog population was found to be 475. Our study demonstrated that mobile technology enabled efficient team management and real-time data entry and analysis. The vaccination approach outlined in this study can serve as a guideline for rapid vaccination of large numbers of dogs with a high coverage rate in free roaming dog populations in India in the future.

A Nationwide Study Comparing Knowledge and Beliefs about HPV among Female Students before and after HPV Vaccination

To assess the knowledge and beliefs regarding human papillomavirus (HPV) and the HPV vaccine among girls before and after vaccination in the Malaysian HPV Immunisation Programme. A nationwide longitudinal survey. Thirty-two randomly selected schools from 13 states and 3 federal territories in Malaysia from February to March 2013, and October to November2013. Form One female students (13years old). None. Mean knowledge score of HPV infection. A total of 2644 students responded to the prevaccination survey, of whom 2005 (70%) completed the postvaccination survey. The mean knowledge score was 2.72 (SD±2.20) of a maximum score of 10 in the prevaccination survey, which increased significantly to 3.33 (SD±1.73) after the 3 doses of HPV vaccine (P=.001). Many answered incorrectly that, "Only girls can get HPV infection" (91.5%, n = 1841prevaccination vs 96.1%, n = 1927 postvaccination), and only a few were aware that, "Vaccinating boys helps to protect girls against HPV infection" (11.4%, n = 229 for prevaccination vs 10.2%, n = 206 for postvaccination). The mean knowledge score was significantly higher postvaccination among higher-income families and those with parents of a higher occupational status. Regarding beliefs about the HPV vaccine, 89.4% in the prevaccination survey held the view that they would not get a HPV infection, and the percentage remained similar in the postvaccination survey. Perceived severity of HPV infection also remained low in the pre- and postintervention groups. Only 21.5% reported receiving health information about HPV along with the provision of the HPV vaccine; those who received health information showed higher levels of knowledge. Findings revealed a general lack of knowledge and erroneous beliefs about HPV and the HPV vaccine even after receiving vaccination. This suggests that imparting accurate knowledge about HPV along with vaccine administration is essential. Specifically, girls from lower socioeconomic groups should be a target of educational intervention.

Awareness of human papillomavirus after introduction of HPV vaccination: a large population-based survey of Scandinavian women.

Using a large, population-based survey, we assessed the levels and correlates of human papillomavirus (HPV) awareness among Scandinavian women after introduction of HPV vaccination. In 2011-2012, a random sample of women aged between 18 and 45 years from Denmark, Sweden and Norway received a questionnaire on lifestyle, health and HPV awareness. We included 47 895 women (response rate 60.6%) in our study. Country-specific and age-specific proportions of women who had heard of HPV in 2011-2012 (postvaccination survey) were compared with corresponding proportions in an identical survey from 2004-2005 (prevaccination survey, n=54 079, response rate 71.3%). Correlates of HPV awareness in the postvaccination survey were assessed by logistic regression. In all countries and age groups, awareness of HPV increased from the prevaccination to the postvaccination survey. In the postvaccination survey, HPV awareness was higher in Denmark (75.8%) and Sweden (74.8%) compared with Norway (62.4%), with greatest discrepancy among women aged between 18 and 19 years (Denmark: 74.9%, Sweden: 70.4%, Norway: 39.6%). Variables associated with low HPV awareness included the following: low education [≤12 vs. >16 years of schooling: odds ratio (OR)=0.45, 95% confidence interval (CI): 0.42-0.48], being a virgin (vs. nonvirgins: OR=0.74, 95% CI: 0.66-0.83), never having used condoms (vs. ever: OR=0.62, 95% CI: 0.56-0.67), nonuse of contraception at first intercourse (vs. use: OR=0.83, 95% CI: 0.79-0.88) and daily smoking (vs. never: OR=0.86, 95% CI: 0.80-0.92). HPV awareness in Scandinavia has increased since the introduction of HPV vaccination. However, 24-38% of Scandinavian women still have never heard of HPV. Future information efforts should target groups with low HPV awareness.

Vaccinate-assess-move method of mass canine rabies vaccination utilising mobile technology data collection in Ranchi, India.

BackgroundOver 20 000 people die from rabies each year in India. At least 95 % of people contract rabies from an infected dog. Annual vaccination of over 70 % of the dog population has eliminated both canine and human rabies in many countries. Despite having the highest burden of rabies in the world, there have been very few studies which have reported the successful, large scale vaccination of dogs in India. Furthermore, many Indian canine rabies vaccination programmes have not achieved high vaccine coverage.MethodsIn this study, we utilised a catch-vaccinate-release approach in a canine rabies vaccination programme in 18 wards in Ranchi, India. Following vaccination, surveys of the number of marked, vaccinated and unmarked, unvaccinated dogs were undertaken. A bespoke smartphone ‘Mission Rabies’ application was developed to facilitate data entry and team management. This enabled GPS capture of the location of all vaccinated dogs and dogs sighted on post vaccination surveys. In areas where coverage was below 70 %, catching teams were re-deployed to vaccinate more dogs followed by repeat survey.ResultsDuring the initial vaccination cycle, 6593 dogs were vaccinated. Vaccination coverage was over 70 % in 14 of the 18 wards. A second cycle of vaccination was performed in the 4 wards where initial vaccination coverage was below 70 %. Following this second round of vaccination, coverage was reassessed and found to be over 70 % in two wards and only just below 70 % in the final two wards (66.7 % and 68.2 %, respectively).ConclusionOur study demonstrated that mobile technology enabled efficient team management and rapid data entry and analysis. The vaccination approach outlined in this study has the potential to facilitate the rapid vaccination of large numbers of dogs at a high coverage in free roaming dog populations in India.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1320-2) contains supplementary material, which is available to authorized users.

Higher Tetanus Toxoid Immunity 2 Years After PsA-TT Introduction in Mali.

Background. In 2010, mass vaccination with a then-new meningococcal A polysaccharide–tetanus toxoid protein conjugate vaccine (PsA-TT, or MenAfriVac) was undertaken in 1- to 29-year-olds in Bamako, Mali. Whether vaccination with PsA-TT effectively boosts tetanus immunity in a population with heterogeneous baseline tetanus immunity is not known. We assessed the impact of PsA-TT on tetanus toxoid (TT) immunity by quantifying age- and sex-specific immunity prior to and 2 years after introduction.Methods. Using a household-based, age-stratified design, we randomly selected participants for a prevaccination serological survey in 2010 and a postvaccination survey in 2012. TT immunoglobulin G (IgG) antibodies were quantified and geometric mean concentrations (GMCs) pre- and postvaccination among all age groups targeted for vaccination were compared. The probability of TT IgG levels ≥0.1 IU/mL (indicating short-term protection) and ≥1.0 IU/mL (indicating long-term protection) by age and sex was determined using logistic regression models.Results. Analysis of 793 prevaccination and 800 postvaccination sera indicated that while GMCs were low pre–PsA-TT, significantly higher GMCs in all age–sex strata were observed 2 years after PsA-TT introduction. The percentage with short-term immunity increased from 57.1% to 88.4% (31.3-point increase; 95% confidence interval [CI], 26.6–36.0;, P < .0001) and with long-term immunity increased from 20.0% to 58.5% (38.5-point increase; 95% CI, 33.7–43.3; P < .0001) pre- and postvaccination.Conclusions. Significantly higher TT immunity was observed among vaccine-targeted age groups up to 2 years after Mali's PsA-TT mass vaccination campaign. Our results, combined with evidence from clinical trials, strongly suggest that conjugate vaccines containing TT such as PsA-TT should be considered bivalent vaccines because of their ability to boost tetanus immunity.

Evaluation of methods for short-term marking of domestic dogs for rabies control

Rabies transmitted by domestic dogs is a serious yet neglected public health threat in many underserved communities in Africa and Asia. Achieving 70% vaccination coverage in dog populations through annual mass vaccination campaigns is an effective means of controlling the disease in these communities. Evaluating the extent to which this target coverage is achieved requires either accurate pre-campaign estimates of the dog population size or accurate estimates of the coverage attained by conducting post-vaccination surveys. Short-term marking of dogs by applying visible marks may be useful to achieve these estimates, but will be affected by the performance of the marking methods. We evaluated the longevity and visibility of two readily-available livestock marking methods applied to owned, free roaming dogs.We applied two types of marks (spray and crayon) with three different colours (red, blue and green) to each of 21 dogs and compared the time of persistence of the marks over several weeks. Two independent observers assessed the visibility and colour of the marks. Each dog was observed over 8–37 days (median: 28 days). Kaplan–Meier survival analyses and semi-parametric log-rank tests were performed separately for both observers. Spray marks remained visible significantly longer (median of 24 days for both observers) compared with crayon marks (medians of 10 and 13 days). After 10 days, 90% of spray marks were still visible, compared with only 46% of crayon marks. Visibility of marks was reduced in darker-coloured dogs. Colours of marks were frequently misclassified, and agreement between observers on the colours of the marks was low (Cohen’s kappa coefficient=0.27).The livestock marker spray can effectively be used to mark dogs that are physically restrained, for example during vaccination campaigns. Resight surveys should be conducted within a short a time as possible after marking; however, our results suggest that loss of marks will not have a significant impact if surveys are conducted within 5–7 days after marking with the spray. Results that depend on observers’ abilities to distinguish between the three colours which we evaluated may not be reliable.

Control of HBV and HDV infection in an isolated pacific Island: 1. pattern of infection

Hepatitis B virus (HBV) and hepatitis delta virus (HDV) infections are known to be hyperendemic in Nauru. Because of the consequences of chronic HBV infection, the Nauruan Government has commenced a program that aims to reduce and eventually eliminate hepatitis B infection by immunizing susceptible adults and children on the island and every newborn baby. At the outset of this program, a national seroepidemiological survey was undertaken. Eighty-eight percent of the population were tested, of whom 69.1% had markers of HBV infection. Evidence of superinfection with HDV was found in 22.7% of HBV carriers, with the highest prevalence in adolescents and young adults. All seronegative individuals were offered three doses of plasma derived hepatitis B vaccine. A post-vaccination survey of 64% of those vaccinated showed that 98% had developed circulating antibodies.

Immunization Against Yellow Fever

Summary 1. Protective antibody against yellow fever virus is demonstrable in the serum of rhesus monkeys within 6 or 7 days after inoculation with standard 17D yellow fever vaccine virus. 2. Rhesus monkeys are completely resistant to the inoculation of highly virulent pantropic yellow fever virus within 5 or 6 days after injection of 17D vaccine. This resistance is present prior to the appearance in the serum of demonstrable protective antibody. 3. Protective antibody is demonstrable in man in a high per cent of cases by the 10th day after injection of 17D vaccine and may be present as early as the 7th day. 4. Postvaccination surveys of immunity were made in persons inoculated in Africa with 17D vaccine prepared in New York, and revealed the following: a. 92.2 per cent of military personnel sampled 1 to 22 months after vaccination exhibited protective antibody. b. 90 per cent of civilians inoculated in Kenya exhibited protective antibody in their sera 23 to 36 months after receiving the vaccine. c. More than 90 per cent of persons vaccinated in Uganda had protective sera after 3 years, and there was no decline in the incidence of immunity during the third year. d. The percentage of children who became immune as the result of inoculation was as great as that in adults, and the antibody response was equally well maintained.