Immunization Rates Research Articles

Leveraging Data from a Provincial Electronic Immunization Registry to Analyze Immunization Coverage, Timeliness, and Defaulters Among 8.8 Million Children from the 2018 to 2023 Birth Cohorts in Sindh Province, Pakistan

Background/Objectives: Full immunization coverage in Pakistan remains suboptimal at 66%. An in-depth assessment is needed to understand the long-term trends in immunization and identify the extent of defaulters and associated risk factors of them being left uncovered by the immunization system. Methods: We conducted a 5-year analysis using the Government’s Provincial Electronic Immunization Registry data for the 2018–2023 birth cohorts in Sindh province. We analyzed 8,792,392 child-level immunization records from 1 January 2018 to 31 May 2024 to examine trends in immunization coverage, timeliness, defaulter rates, and associated risk factors; Results: Our findings indicate gradual improvements in immunization coverage, with full immunization rates increasing by 23.2% (from 47.5% to 70.7%) from 2018 to 2022. While timeliness declined from 2018 to 2021, it recovered in 2022 and 2023. Over the 5-year study period, >90% of children defaulted on vaccinations, with 34.8% fully covered and 9.1% uncovered. Children from urban areas (OR = 1.54; 95% CI = 1.52, 1.56; p-value < 0.001) and those enrolled through fixed immunization sites (OR = 2.11; 95% CI = 2.08, 2.15; p-value < 0.001) and mobile immunization vans (OR = 1.13; 95% CI = 1.13, 1.77; p-value = 0.003) were at higher risk of being uncovered defaulters. Conclusions: This study demonstrates improvements in immunization coverage in Sindh while highlighting the challenge of low timeliness and high default rates. Our findings provide insights to strengthen immunization access and timeliness, particularly in high-default areas, and can guide policies in similar low-income settings for more equitable and comprehensive immunization coverage.

RNA N6-Methyladenosine-Binding Protein YTHDFs Redundantly Attenuate Cancer Immunity by Downregulating IFN-γ Signaling in Gastric Cancer.

Immunotherapy holds potential as a treatment for gastric cancer (GC), though immune checkpoint inhibitor (ICI) resistance remains an obstacle. One resistance mechanism involves defects in interferon-γ (IFN-γ) signaling, in which IFN-γ is linked to improved responsiveness to ICIs. Herein, the roles of RNA N6-methyladenosine (m6A) modifications in regulation of IFN-γ signaling and the responsiveness to ICIs are unveiled. The m6A-binding protein YTH N6-methyladenosine RNA-binding protein F1 (YTHDF1) is overexpressed in GC tissues, correlating with the suppression of cancer immunity and poorer survival rates. YTHDF1 overexpression impaired the responsiveness to IFN-γ in GC cells, and knockdown studies indicated the redundant effects of YTHDF2 and YTHDF3 with YTHDF1 in IFN-γ responsiveness. RNA immunoprecipitation sequencing revealed YTHDFs directly target interferon regulatory factor 1 (IRF1) mRNA, a master regulator of IFN-γ signaling, leading to reduced RNA stability and consequent downregulation of IFN-γ signaling. Furthermore, in mouse syngeneic tumor models, Ythdf1 depletion in cancer cells resulted in reduced tumor growth and increased tumor-infiltrating lymphocytes, which are attributed to the augmentation of IFN-γ signaling. Collectively, these findings highlight how YTHDFs modulate cancer immunity by influencing IFN-γ signaling through IRF1 regulation, suggesting their viability as therapeutic targets in cancer immunotherapy.

HPV vaccine hesitancy among parents and caregivers of adolescents in Northern Nigeria

BackgroundThe recent introduction of the HPV vaccine into Nigeria's routine immunization schedule has brought parental vaccine hesitancy to the forefront. This cross-sectional study, conducted in Kano State, a region with historically low immunization rates, is crucial in assessing the level of parental hesitancy and uncovering its determinants, potentially informing future public health policies. MethodsThe participants were a representative sample of parents or caregivers of children aged 9–14 years (n = 1071) in Kano State and were selected via a multi-stage sampling method. We administered structured questionnaires anchored in the Socio-ecological Model and the Precaution Adoption Process Model. We utilized validated measures to assess intent to vaccinate against HPV and potential key indicators of intent to vaccinate adolescent boys and girls. Multivariate logistic regression analysis was performed to determine predictors of parental HPV vaccine hesitancy. ResultIf the HPV vaccine were free or subsidized, about one-third [32.7 %] of parents would choose not to vaccinate their children against the virus. Only 4.2 % had ever heard of HPV, and a mere 5.1 % had heard of the cervical cancer vaccine or HPV vaccine. Compared to those who were aware of the virus, those who had never heard of HPV had higher adjusted odds of vaccine hesitancy [OR: 2.86, 95 %CI: 1.28–6.40]. Some of the top reasons for parental hesitancy were their concerns about the safety of the vaccine and the lack of doctors' recommendations. ConclusionThe study revealed that parental hesitancy is a significant barrier to HPV uptake in Kano State. There is an urgent need for a multi-faceted HPV knowledge enhancement approach focusing on elevating parental awareness about the HPV vaccine and, particularly, its relationship to cervical cancer prevention.

Discovery of an theranostic functional mAb for visualizing the sensitivity and effectiveness of PD-L1 checkpoint therapy

To address the challenges of inconsistent efficacy, low sensitivity, and subjective screening methods faced by PD-L1-targeted immune checkpoint therapies in the clinic. We propose to construct a therapeutic functional monoclonal antibody with tracking capability using tetrazolium-based bioorthogonal reaction turn-on fluorescence technology, focusing on the molecular biomarker PD-L1 for easy visualisation of therapeutic response. This therapeutic monoclonal antibody enables bioorthogonal reaction turn-on fluorescence to monitoring of tumors with varying degrees of PD-L1 expression, while preserving the activity of the PDL1 monoclonal antibody and improve the immune activation rate and achieve efficient anti-tumor effects. In conclusion, our proposed family of bio-orthogonal reaction-driven fluorescence turn-on methods can be used to identify therapeutic bifunctional monoclonal antibodies to PD-L1, which can be employed alongside the screening of PD-L1 antibodies for therapeutic effects.Abbreviations: CRT, Calreticulin; DCs, Dendritic cells; ELISA, Enzyme-linked immunosorbent assay; IFN-γ, Interferon-γ; IL-2, Interleukin-2; IHC, Immunohistochemistry; WB, Western blot.

Federally Qualified Health Centers and Performance of Medicare Accountable Care Organizations

Federally qualified health centers (FQHCs) have increasingly participated in the Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs), one of the most widespread value-based programs. Although FQHCs may strengthen ACOs' ability to provide affordable care to diverse Medicare beneficiaries, evidence on ACOs' performance by FQHC participation is limited. To compare beneficiary characteristics, utilization, expenditure, and quality between ACOs with and without FQHC participation and assess changes in ACO performance after including first FQHCs. Using MSSP public use files, this cross-sectional study compared performance of ACOs that always had FQHC participation with ACOs that never had FQHC participation from January 1, 2016, to December 31, 2022, supplemented with staggered difference-in-differences analyses of ACOs' first-time inclusion of FQHCs on performance measures. Data analysis was performed from December 1, 2023, to February 29, 2024. Participation of FQHCs in the MSSP. Measures of ACO-assigned beneficiaries, utilization, expenditure, and quality per ACO-year. Among 752 ACOs in the descriptive analysis, 140 ACOs always had at least 1 FQHC participant, whereas 612 ACOs never had FQHC participants. Compared with ACOs that never had FQHC participation, those that always had FQHC participation provided care to more socioeconomically disadvantaged beneficiaries (mean [SD] with dual eligibility, 2035.8 [2110.6] vs 1040.9 [1084.2] person-years; with disability, 3341.1 [3474.9] vs 1705.1 [1664.9] person-years; in racial and ethnic minoritized groups, 3690.6 [4118.4] vs 2515.1 [2762.9] person-years), with fewer primary care visits (mean [SD], 9956.6 [1926.3] vs 10 858.8 [2383.4] per 1000 person-years), more emergency department visits (mean [SD], 771.6 [190.9] vs 657.2 [160.0] per 1000 person-years), and lower levels of several quality measures. In the difference-in-differences analysis, 43 ACOs included FQHCs for the first time. Including first FQHCs was associated with increases of 872.9 dual-eligible (95% CI, 345.9-1399.8), 1137.6 disability (95% CI, 390.1-1885.1), and 1350.8 racial and ethnic minority (95% CI, 447.4-2254.1) person-years, with increases in rates of influenza immunization (5.9 percentage points [pp]; 95% CI, 1.4-10.4 pp), tobacco screening and cessation intervention (11.8 pp; 95% CI, 3.7-20.0 pp), and depression screening and follow-up (8.9 pp; 95% CI, 0.5-17.4 pp). No associations were observed between FQHC inclusion and utilization or expenditure. In this repeated cross-sectional study, MSSP ACOs with FQHC participation served more socioeconomically disadvantaged Medicare beneficiaries than those without FQHC participation. The inclusion of first FQHCs was associated with increased rates of several preventive services without increasing costs. Participation of safety net practices appeared to improve access to ACOs among beneficiaries from underserved communities.

Myths and misinformation associated with vaccine incompleteness: A survey study

ObjectiveVaccine hesitancy is a relevant driver of backslides in immunization rates globally. Myths and misinformation are key contributors to vaccine hesitancy. We aimed to investigate associations between beliefs in popular vaccine myths and vaccine incompleteness. MethodsIn this survey, participants were asked questions on current vaccination status; barriers and motivations for vaccination; and beliefs regarding popular myths: the measles vaccine causes autism in children; acquiring the disease is preferable to facing vaccine side effects; and natural immunity developed from getting the disease is better than the immunity elicited by vaccination. We assessed the effect of failing to disagree with the myths on current vaccination status. ResultsOf 4305 participants, 933 (22 %) were partially vaccinated and 61 (1 %) were fully unvaccinated; 403 (10 %) failed to disagree with the autism myth; 411 (10 %) failed to disagree with the side effects myth; and 904 (22 %) failed to disagree with the natural immunity myth. Failing to disagree with the myths was significantly associated with vaccine incompleteness. ConclusionVaccine-related myths are associated with both partial and total vaccine incompleteness in Brazil. Practice implicationsStrategies to improve adherence to vaccination recommendations should include interventions to limit the spread or elucidate vaccine-related myths and misconceptions.

The Immunomodulatory Effect of Intraperitoneal Injection of Licorice Extract on Giant Salamander

The effect of licorice extract on non-specific immune function of giant salamanders was studied by intraperitoneal injection. The results showed that the lysozyme activity in the drug group increased, and the lysozyme activity increased with the increase of dose. From the 7th day onwards, each sampling of the drug group showed significant differences compared to the control group (P<0.05). The phagocytic activity of macrophages in the drug group showed some fluctuations, but there was no significant difference compared to the control group. The white blood cell volume value of the high-dose group gradually increased in the first three samplings, and showed a significant difference compared to the control group at 14 days (P<0.05). It decreased slightly in the last two samplings, but was still higher than the control group at the same time. The spleen organ coefficient of the low-dose group was (0.7 ± 0.01) % at 28 days, higher than that of the control group (0.4 ± 0.05) %, and the high-dose group was (0.7 ± 0.07) % at 14 days, higher than that of the control group (0.4 ± 0.02) %. Both differences were significant (P<0.05). After the last sampling (28 days), artificial infection with <i>Aeromonas hydrophila</i> bacteria resulted in a mortality rate of 80% in the control group, 50% in the low-dose group, and 30% in the high-dose group, all lower than the control group. The drug group also had higher immune protection rates than the control group. The results indicate that intraperitoneal injection of licorice extract can improve the immune function and disease resistance of giant salamanders to a certain extent.

TMIC-14. RAPID EARLY PROGRESSION IN GLIOBLASTOMA: A COMPREHENSIVE REVIEW OF CLINICAL, IMAGING AND HISTOPATHOLOGICAL FEATURES

Abstract BACKGROUND In glioblastoma patients, Rapid Early Progression (REP) refers to tumour growth between the time of surgery and postoperative chemoradiotherapy. Despite its high incidence relatively little is known about it. The aim of this study was to characterise REP using a combination of clinical, imaging and histopathology data. METHODS Ethical approval was obtained. Supratentorial IDH-wildtype glioblastomas undergoing gross-total resection (GTR) between 2015-2021 were included. REP was defined as a nodular increase in enhancement located within or around the surgical cavity, occurring within 6 weeks of surgery, that was not accounted for by initial areas of diffusion-restriction. REP cases were propensity-score matched to controls on baseline characteristics. Imaging was compared using mean apparent diffusion coefficient (ADC) and T1-postcontrast radiomics. Tissue analyses included DNA methylation subtyping and immunohistochemistry for markers of T-cells (CD3), microglia (P2RY12) and proliferation (PHH3). RESULTS REP occurred in 8/60 GTR cases (13%) and these patients were matched to 16 controls. REP cases had a worse preoperative performance status (median Eastern Cooperative Oncology Group [ECOG] 2 vs. 1), overall-survival (p=0.038) and progression-free survival (p = 0.029). REP was more common in patients over 65 years (27%) and significantly fewer REP patients received radical postoperative chemoradiotherapy (p=0.023). REP and control cases were well matched with respect to preoperative T1-postcontrast radiomics and mean ADC in enhancing (p=0.99) and non-enhancing regions (p=0.67). There was no relative excess of any one DNA methylation subtype in REP cases. The two groups had a similar proportion of T-cells (p=0.81), but REP cases had a trend towards a higher proportion of microglia (31% vs. 17%; p=0.22), and a lower proliferation rate (3% vs. 9%; p=0.19). CONCLUSION REP cases had a worse performance status from diagnosis and received less radical postoperative chemoradiotherapy protocols compared to controls, yielding a significantly shorter median OS/PFS. Differences in immune landscape and proliferation rate should be further investigated.

Protective immune-response of Aeromonas hydrophila phage lysate in crucian carp against direct virulent challenge with A. hydrophila-TPS

Aeromonas hydrophila was a common opportunistic pathogen that was widely found in various aquatic environment and could cause multiple infections in humans and animals. The haemorrhagic septicemia and bacterial enteritis in fish triggered by this pathogen led to significant losses in the aquaculture industry. In this study, we aimed to develop a phage lysate vaccine by lysing the A. hydrophila-TPS strain using phage PZY-Ah, which was previously isolated and preserved in the laboratory. First, we focused on optimizing phage lysis conditions, including different host bacteria culture time, phage lysis time, and phage to bacterial ratios. The optimal conditions were established as follows: culturing the A. hydrophila-TPS strain for 6 h, adding phage at a ratio of 1:10, and mixing for 4 h, which resulted in maximum lysis of the host bacteria. Subsequently, we assessed the immune responses of groups receiving formaldehyde-inactivated vaccines compared to those receiving various concentrations of the phage lysate vaccine. Both the TPS-phage lysate and formaldehyde-inactivated vaccine groups exhibited increased levels of specific immune enzymes (ACP, AKP, LZM, SOD, CAT) and cytokines (IL-1β, TNF-α and IFN-γ) in serum, as well as enhanced humoral immunity (IgM, C3 and C4) in crucian carp. Furthermore, challenge tests conducted post-immunization demonstrated that the high concentration of the TPS strain-lysate vaccine group (1 × 108 CFU/mL) achieved the highest immune protection rate at 88.89 %. Overall, the development of the TPS-phage lysate vaccine significantly enhanced the immunity of crucian carp, providing a higher level of protection and establishing a foundation for the research and development of phage-based aquatic vaccines.

A theranostic photosensitizer-conjugated albumin co-loading with resiquimod for cancer-targeted imaging and robust photo-immunotherapy

Cancer immunotherapy remains a low immune response rate in clinic because of dominant immunosuppressive tumor microenvironment (TME) and lack of effective drug to specifically remodel the TME. In this work, we introduced a tumor-seeking human serum albumin (HSA) based delivery platform by covalently conjugating with a tumor-targeting near-infrared (NIR) photosensitizer (IR-DBI) and non-covalently loading of immune modulator Resiquimod (R848). HSA exhibited tumor-preferential accumulation after covalent conjugation with IR-DBI. Meanwhile, HSA restricted the rotation of IR-DBI, narrowed the HOMO-LUMO energy gap, significantly enhanced fluorescent intensity and dual-modal phototherapy (PTT/PDT). The enhanced phototherapeutic effect further induced robust ICD effect. More importantly, non-covalent loading of R848 could be released from HSA at tumor sites by laser irradiation-induced heat. The in-situ release of R848 in TME efficiently promoted the maturation of DC cells and repolarized M2 macrophages to M1 macrophages. Consequently, robust photo-induced antitumor immunity was triggered in the different mice models bearing primary and distant tumors or lung metastasis, which was further enhanced by combining with CTLA-4 blockade therapy. Taken together, this work may present a versatile albumin composite which exhibits tumor-preferential accumulation and imaging-guided PDT/PTT/immunotherapy.

AI based predictive acceptability model for effective vaccine delivery in healthcare systems

Vaccine acceptance is a crucial component of a viable immunization program in healthcare system, yet the disparities in new and existing vaccination adoption rates prevail across regions. Disparities in the rate of vaccine acceptance result in low immunization coverage and slow uptake of newly introduced vaccines. This research presents an innovative AI-driven predictive model, designed to accurately forecast vaccine acceptance within immunization programs, while providing high interpretability. Primarily, the contribution of this study is to classify vaccine acceptability into Low, Medium, Partial High, and High categories. Secondly, this study implements the Feature Importance method to make the model highly interpretable for healthcare providers. Thirdly, our findings highlight the impact of demographic and socio-demographic factors on vaccine acceptance, providing valuable insights for policymakers to improve immunization rates. A sample dataset containing 7150 data records with 31 demographic and socioeconomic attributes from PDHS (2017–2018) is used in this paper. Using the LightGBM algorithm, the proposed model constructed on the basis of different machine-learning procedures achieved 98% accuracy to accurately predict the acceptability of vaccines included in the immunization program. The association rules suggest that higher SES, region, parents’ occupation, and mother’s education have an association with vaccine acceptability.

Assessment of childhood vaccination hesitancy among syrian parents under temporary protection

Background and AimVaccination programs become increasingly crucial during migratory movements driven by conflict and other disruptions. This study aims to determine the prevalence of childhood vaccination hesitancy among Syrian parents under temporary protection and identify areas for targeted interventions.MethodA total of 227 Syrian parents attending three Immigrant Health Centers in Sultangazi were assessed using the Arabic version of the Parent Attitude about Childhood Vaccines (PACV) survey, conducted between October and December 2023.ResultsThe prevalence of vaccine hesitancy among these parents was found to be 10.6%. An inverse correlation was observed between maternal education level and vaccine hesitancy, indicating that higher education levels were associated with lower levels of hesitancy.ConclusionThe observed rate of vaccine hesitancy among Syrian parents under temporary protection underscores the urgent need for targeted interventions. Tailored vaccination strategies for immigrant populations are essential to improve immunization rates and ensure the health and well-being of these communities.

Human Papillomavirus Vaccination Awareness and Uptake among Healthcare Students in Japan

BackgroundThe vaccination rate for HPV (Human Papillomavirus) has remained significantly low in Japan because of the administrative suspension of active recommendation. This study investigates the awareness and uptake of the HPV vaccine among healthcare students in Japan following the reinstatement of active recommendation for young women in April 2022. MethodsA web-based survey was administered to 2,567 healthcare students from Okayama and Shujitsu Universities in Japan in July 2023. The survey assessed participants' backgrounds, immunization status, awareness of vaccine recommendations, and knowledge of cervical cancer across various demographics, including sex, academic year, and department (Medicine, Health Science, Pharmaceutical, and Dentistry). ResultsThe response rate was 36.3% (933 students; 181 male, 739 female, and 13 unspecified gender). The overall immunization rate among female students was 55.6%, with higher rates observed in medical (73.8%) and dental (63.0%) students. Awareness of the government's change in vaccine recommendation was notably high among female and senior male students. Over half of the female students (54.7%) reported receiving vaccinations based on their parents' advice. Among those unvaccinated but interested in future immunization, concerns about adverse reactions (47.4%) and challenges in scheduling vaccinations (29.1%) were predominant. ConclusionHealthcare students exhibited a higher HPV vaccination rate than the general population. Ongoing education to improve vaccine literacy is crucial for augmenting HPV vaccination rates in Japan.

Opt-out vaccination in school and daycare: Reconciling parental authority and obligations.

An increasing vaccine hesitancy among parents, which has resulted in insufficient rates of immunization, provides reason to reconsider childhood vaccination practices. Studies suggest that parents' decision-making process concerning whether to vaccinate their child is highly influenced by cognitive biases. These biases can be utilized to increase vaccination uptake via changes in the choice context. This article considers childhood vaccination programmes, which involve children being vaccinated in school or daycare unless their parents actively 'opt out'. We suggest that such programmes reconcile parents' decisional authority and vaccination duties. First, opt-out childhood vaccination based in schools or daycare centres are not disrespectful of parental authority. Second, the programme aligns the default setting with a moral obligation to vaccinate one's child that most parents have.

Landscape of targeted therapies for lung squamous cell carcinoma.

Lung cancer, a common type of malignant neoplasm, has seen significant advancements in the treatment of lung adenocarcinoma (LUAD). However, the management of lung squamous cell carcinoma (LSCC) continues to pose challenges. Traditional treatment methods for LSCC encompass surgical resection, chemotherapy, and radiotherapy. The introduction of targeted therapy and immunotherapy has greatly benefited LSCC patients, but issues such as limited immune response rates and adverse reactions persist. Therefore, gaining a deeper comprehension of the underlying mechanisms holds immense importance. This review provides an in-depth overview of classical signaling pathways and therapeutic targets, including the PI3K signaling pathway, CDK4/6 pathway, FGFR1 pathway and EGFR pathway. Additionally, we delve into alternative signaling pathways and potential targets that could offer new therapeutic avenues for LSCC. Lastly, we summarize the latest advancements in targeted therapy combined with immune checkpoint blockade (ICB) therapy for LSCC and discuss the prospects and challenges in this field.

ÍNDICE DE IMUNIZAÇÃO DE TUBERCULOSE NO MUNÍCIPIO DO SUL DO TOCANTINS-GURUPI-TO.

The present article in question focuses on the tuberculosis immunization rate in the municipality of Gurupi, which is located in the south of the state of Tocantins. Tuberculosis is an infectious disease caused by Koch’s Bacillus (Mycobacterium tuberculosis) and transmissible in its pulmonary form. In this study, a quantitative research of a documentary, statistical and retrospective nature was carried out as a data collection instrument, in addition to searching for concepts in some articles collected in the databases of the virtual library Scielo, Lilacs, Google Scholar that were related to the topic addressed and to the intended objectives. The data collected on the Datasus platform were tabulated in tables with the various variables found, including age, race, sex, education level, among others. Therefore, epidemiological research showed an expansion of tuberculosis in the last 10 years in the municipality. From this perspective, the predominance of male tuberculosis cases stands out, in a mixed-race population and people with only elementary school education.

Investigating T Cell Immune Dynamics and IL-6's Duality in a Microfluidic Lung Tumor Model.

Interleukin 6 (IL-6), produced by immune cells, is crucial in promoting T cell trafficking to infection and inflammation sites, influencing various physiological and pathological processes. Concentrations of IL-6 and other cytokines and chemokines can influence T cell differentiation and activation. Understanding the dual faces of IL-6 within the tumor microenvironment is crucial to understanding its role. A flow-based microsystem was designed to investigate CD4+ T cell activation in response to different IL-6 gradients in an under-control 3D culture. The study found that cancer cells' response to varying IL-6 concentrations was dynamic and dose-sensitive, with immune cell migration rates showing sensitivity to the IL-6 gradient. A549 cell expansion increases gradually and time-dependently with 50 ng of IL-6, while Jurkat cell migration follows a time-dependent pattern. However, when a total of 100 ng IL-6 concentration is applied, A549 cells expand rapidly, potentially influencing Jurkat cell migration. Jurkat cell mobility is lower, possibly due to increased A549 cell presence and heightened cell-cell interactions. Different IL-6 concentration gradients can modulate the expression of some CD markers like CD69 and programed cell death protein 1 in CD4+ T cells, suggesting that IL-6 concentration gradients affect immune cell phenotypes. This suggests that IL-6 plays a crucial role in activating T helper cells and may be involved in the later phases of inflammation. Also, the increased levels of IFN-γ and TNF-α highlight IL-6's impact on T cell inflammatory response. This study emphasizes the intricate effects of IL-6 on T cell activation, phenotype, cytokine production, and phenotypic heterogeneity, providing valuable insights into immune response modulation in an experimental setting.

Causes of Dropout from immunization among children in two selected slum area of Dhaka City

This study will contribute information that can be used by policymakers in the Ministry of Health (MOH) to create policies that will encourage mothers to complete their immunization schedule among children in Bangladesh. It will benefit health workers like nurses, doctors or clinicians by giving useful data on the factors associated with immunization dropout among children of one month to 18 months of age in Bangladesh. Materials and Methods: A cross-sectional household survey was conducted in two selected slum area in Dhaka city and 120 married women (60 from each slum area of Dhaka city) were interviewed through face -to-face by the researcher. The target population was the parents had children of age from 1 month to 18 month and had routine child vaccination card were interviewed. The total sample size was 120 in number and they were selected by using systematic sampling technique. The study was based on primary data. The instruments of the study were pretested semi-structured questionnaire. After editing and coding the coded data enter into the computer SPSS Version 16.0 was used to analyze the data. Immunization was categorized into ‘complete’ and ‘drop-out’. Bivariate associations were then evaluate using Chi-square and spearman’s correlation. Logistic regression was finally performed to evaluate the strength of the predictive variables to immunization dropout. A confidence interval of 0.05 was considered in this study. Place and Period of the Study: Study was conducted from 8th January 2022 to 21th February 2022 in Tongi (Arshadnagor, Bank field, Hazi Mazar, Nishad Nagar slums -60 household) and Dhaka north City Corporation (korail slum from Banani -60 household). Results: Among the 120 participants majority that is 84.2% represented the age group of 21-35 years followed by 15.0% of <20 years. Maximum and minimums age of the participant was 37 years & 14 years. Sex distribution of the children showed that out of 120 respondents, 59 (49.2%) were male & 61 (50.8%), were female. Male: Female ratio was 1:1.1. Opinion regarding importance of immunization status showed that 100% participants opinion were immunization was important for child. The study revealed that maximum 85.0% respondents told that immunization center distance is less than 1 km & 15.07% respondents stated it is 2-3 km. The study showed that, out of 100% children 74.2% were fully immunized & 25.8% were partially immunized. Conclusion: According to study findings, out of 100% children 74.2% were fully immunized & 25.8% were partially immunized. It was found that there were no associated factors determined to causes dropout rate of immunization from chi-square test. From spearman correlation test, it was found that there was positive association between dropout rate and sex of the children, type of the family. There is a need for intensified engagement with communities through the reaching every child approach so that children are fully immunized. EWMCJ Vol. 12, No. 1&2, January-July 2024: 14-20

Main challenges and measures taken by public health institutions in response to war in Kyiv Region

Abstract Background The establishment of martial law due to Russia’s military aggression against Ukraine led to specific adjustments in the functioning of the Centers for Diseases Control and Prevention (СDС). The negative impact of hostilities is determined by the increased morbidity rate of communicable and non-communicable diseases, insufficient supply of safe drinking water and food to damaged sites, inadequate living conditions, etc. Objectives The purpose of the work was to create an effective system for responding to biological, chemical and radiation hazards and eliminating the consequences of an emergency situation in the realities of martial law. Methods We used the most common methods, namely descriptive, statistical, microbiological and сhemical laboratory tests. Results The activities of the CDC under martial law include daily monitoring studies of environmental objects. The epidemic situation of acute intestinal infection (AII) and other communicable diseases (CD) is constantly analyzed. The Kyiv Oblast CDC became the basic institution for the implementation of the ‘pilot project’ in the direction of sanitary and epidemic assessment and monitoring of environmetal objects in 188 de-occupied areas. The main public health risks were identified: providing the population with high-quality drinking water; low immunization rate of the population; sites for the location of internally displaced persons; natural foci of especially dangerous diseases, such as tularemia, leptospirosis, infection fevers, etc. In 2022, the overall level of CD in the Kyiv region decreased by 44.0% from 2021. The most common nosologies were acute respiratory viral infections and influenza (98.9%), AII (42.4%), tuberculosis (15.3%), Lyme disease (15.3%), and viral hepatitis (14.2%). Conclusions Based on the research conducted, mechanisms have been developed for responding to hazards of various origins by public health institutions, including risk assessmant and laboratory studies. Key messages • The main focus of the Centers for Diseases Control and Prevention is aimed at effective response to hazards of various origins in order to ensure public health under martial law. • Risk assessment in de-occupied territories has become an important tool for identifying correct approaches to prevent negative consequences for public health.

Analysis of the mpox outbreak in Europe in 2022: vaccination rollout in the most affected countries

Abstract Background The mpox virus spreads through contact with infected material and causes flu-like symptoms and skin lesions. Common in Central and West Africa, a global rise in mpox cases in 2022 was observed, affecting mainly men who have sex with men. Methods The study analysed vaccination policies in the most affected WHO-EURO countries during the mpox outbreak, including the Netherlands, France, UK, Spain, Germany, Belgium, Portugal, and Switzerland. Epidemiological data from May to October 2022 (first wave) were compared. Additionally, the role of EU health institutions in assisting member states in controlling virus spread across the region was examined. Results By the end of May 2022, three countries (The Netherlands, France, and UK) initiated post-exposure vaccination shortly after the first case identification. Portugal, one of the most affected countries, implemented pre-exposure prophylaxis for high-risk groups by September, followed by Switzerland in November. Vaccination access for non-exposed priority groups varied, with France not requiring a medical prescription. EU cooperation in health was pivotal during the outbreak, with vaccines distributed through the EU4Health program budget via HERA to ensure preparedness. However, detailed information remains limited. Conclusions Countries’ responses to the mpox virus outbreak varied significantly, with discrepancies not always aligning with epidemiological data. These differences could stem from various factors, such as behavioural patterns, prior immunisation rates, and neighbouring countries’ policies. However, the unequal access to vaccines across the region underscores existing health disparities, particularly affecting stigmatised populations. Data on immunisation records were notably scarce in most countries, hindering thorough analysis of policy implementation and effectiveness. Additionally, further exploration is warranted into the role of LGBT associations and evidence of stigma surrounding the outbreak. Key messages • The mpox 2022 outbreak in Europe provides an important picture of cross-border health policies and public health responses for future emergences in a European cooperative environment. • Most national authorities provided limited information during the mpox 2022 outbreak; data on immunisation records and vaccine access is pivotal to assess countries’ health policies.