Routine Immunization Services Research Articles

Monitoring experience of World Health Organization external monitor for Intensified Mission Indradhanush 5.0 vaccine drive in rural Cuddalore, Tamil Nadu

The Intensified Mission Indradhanush 5.0 (IMI 5.0) aimed to extend routine immunization services across India, with a focus on children up to 5 years old. Key objectives included boosting measles and rubella vaccination coverage. By September 30, 2023, over 34.6 million children and 6.5 million pregnant women had received vaccine doses nationally. The Surveillance Medical Officer (SMO) from WHO designated external monitors to oversee session sites and perform house-to-house monitoring. Monitoring took place from October 12-14, 2023, in three health blocks of Cuddalore District. Activities included observing two session sites per day (six total) and surveying 40 households per day (120 total). Separate checklists were provided for session site monitoring and house-to-house monitoring, as per WHO guidelines. All session sites adhered to the scheduled times and locations, with proper logistics. However, some lacked IEC materials for public awareness. House-to-house monitoring confirmed full vaccination coverage for under-five children, with no missed vaccinations identified. Recommendations were made to ANMs to have IEC material to enhance community participation. Monitoring of IMI 5.0 in Cuddalore District demonstrated strong adherence to guidelines and effective vaccination session implementation. House-to-house monitoring confirmed appropriate vaccination of under-five children, indicating successful outreach. Overall, this experience provided valuable insights into operational challenges and opportunities for improvement in future immunization campaigns.

Effective integration of COVID-19 vaccination with routine immunization: A case study from Kinshasa, DRC

BackgroundIn response to the challenge of maintaining COVID-19 vaccination coverage amidst the pandemic, VillageReach, in collaboration with the Ministry of Public Health Prevention and Hygiene in Kinshasa, DRC, integrated COVID-19 vaccination with routine immunization services at two primary healthcare facilities. This initiative, launched in July 2022, represented the first of its kind in the DRC, aiming to assess the effectiveness and scalability of a multimodal vaccination approach. MethodsThrough a rapid appraisal involving key informant interviews and analysis of pre- and post-integration service delivery data, this case study explores the operational dynamics and outcomes of integrating COVID-19 and routine immunizations. ResultsResults demonstrated that the integrated approach not only maintained COVID-19 vaccine coverage but also significantly enhanced routine immunization uptake, particularly among under-immunized and zero-dose children. Overall, the vaccination sites, outreach, and integrated health facilities administered 229,983 (33 %) of COVID-19 vaccines in Kinshasa, of which 53 % were referred by community health workers. Additionally, 998 under-immunized children received routine immunizations, of whom 126 were zero-dose children. Key success factors included sustained community health worker engagement, neighborhood-specific strategies, accessible vaccination points, and robust data management. The findings suggest that such integrative strategies can effectively bolster immunization coverage in urban poor communities, offering valuable insights for similar initiatives in the DRC and beyond. ConclusionThis study advocates for sustained investment in innovative immunization models to strengthen primary healthcare systems post-pandemic.

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

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

Assessing the resilience of child immunisation programmes using geospatial modelling and interrupted time series analysis in Ethiopia and Kenya amidst the COVID-19 pandemic: tracking coverage and identifying key challenges

IntroductionThe COVID-19 pandemic disrupted healthcare provision and access in sub-Saharan Africa. Lockdowns and travel restrictions, coupled with fear of contracting the virus, disrupted services, especially for women’s and children’s health,...

Service disruptions, trauma and burnout during the COVID-19 pandemic among healthcare providers delivering immunisation and maternal and child health services in Indonesia

BackgroundThe COVID-19 pandemic resulted in extreme strain on health systems including the health workforce, essential health services and vaccination coverage. We examined disruptions to immunisation and maternal and child health...

Effect of HIV-Integrated Care on Uptake of Maternal Health and Routine Childhood Immunization Services at Primary Health Care Facility in Northern Nigeria: An Interrupted Time Series Analysis

Background: This study assessed the effect of HIV-integrated care delivered within routine primary health care (PHC) in Kano, Nigeria, on the uptake of maternal health and routine childhood immunization services. Methods: A retrospective cohort design was used to review and collect anonymized data from medical records of women and children who accessed health care from the PHC facility between January 2009 and December 2016. Data were analyzed using SPSS version 22. Interrupted time series analysis (ITS) was performed to estimate changes in maternal and childhood immunization service usage over time following the delivery of the integrated care. Results: Uptake of maternal health services increased over time: antenatal care attendance (effect/month [95% confidence interval (CI)]: 6.6 [44.55–8.65], P = 0.0001), family planning (effect/month [95% CI]: 1.3 [0.26–2.26], P = 0.014), and delivery (effect/month [95% CI]: 0.9 [0.39–1.45], P = 0.0009). Uptake of routine immunization also increased over time with the integrated care: Bacille Calmette Guerin (BCG) (Effect/month [95% CI]: 1.8 [0.64–2.88], P = 0.002), and diphtheria, tetanus, and pertussis 1 (DPT1)/Penta 1 vaccinations (Effect/month [95% CI]: 1.0 [0.20–1.73], P = 0.013) also showed a moderate increase over time, but DPT3/Penta 3 vaccination dropped gradually over time (Effect/month [95% CI]: −0.1 [−0.74–0.46], P = 0.649). Conclusion: The integrated care resulted in increased uptake of both maternal health and childhood routine immunization services. This suggests that the reorganization and restructuring of the HIV-integrated care in the Kumbotso Comprehensive Health Centre has had a positive impact on non-HIV services provided at the center. There are still opportunities for further research to refine and elaborate on the novel findings of this study.

Assessment of Accredited Social Health Activists (ASHAs) Regarding Their Roles and Responsibilities in Selected Villages of a District in India: A Qualitative Study

Background: Vaccination in children against vaccine preventable diseases is an important public healthintervention. ASHAs are receiving performance-based incentives for promoting universal immunisation. A recent local outbreak of Measles in two health Blocks of Rajouri district prompted us to conduct this study. The objectives of this study were to study the awareness and perception of ASHAs regarding their roles and responsibility in delivering routine immunization services to children and to study the factors affecting their performance in delivery of routine immunization services to children.Methods: It was a qualitative study; non-probability sampling method was used for selection of subjects. Data was collected through interview and analysed using thematic framework approach.Conclusion: The study revealed that ASHAs were aware of their roles and responsibilities except few in delivery of routine immunization services to children. Delayed and Poor incentives, Lack of proper transport and hilly area were the demotivating factors. Support from community members and Health Staff, and Supportive supervision were the motivating factors for ASHAs in delivery of routine immunization service to children. Periodic training, better and timely incentives and proper transportation for ASHAs are required to augment the immunization service delivery to the children.

IJCM_205A: A qualitative study to assess factors affecting the uptake of measles vaccine in a metropolitan city

Background: Measles is a communicable and potentially fatal, but vaccine- preventable disease. India has set a target of 95% vaccination coverage for Measles-Rubella elimination by the end of 2023 with the help of Intensified Mission Indradhanush (IMI 5.0). The National Immunization Schedule of India recommends two doses of Measles-Rubella (MR) vaccine at 9 months and 16-24 months. The immunization coverage dropped across the globe during the COVID-19 pandemic during the year 2020-2021. Consequently, there was a recent surge in measles cases in some Indian states. The state of Maharashtra reported over 3000 cases; and its capital city Mumbai reported with over 400 cases in December 2022. Various factors such as fear of side effects, lack of information and ignorance have been found to influence vaccine uptake. Objective: To determine the factors associated with the uptake of measles vaccine in the community. Methodology: The study data collection was conducted during November- December 2023, in the M-east municipal ward of Mumbai, using Qualitative research methods until data saturation, i.e., In-depth Interviews and Focus- Group Discussions. 1. On a one-to-one basis, In-depth Interviews (IDI) were conducted among health authorities and healthcare workers involved in the immunization program, from the Public Health Department of Mumbai. 2. Focus-Group Discussions were conducted with a homogenous group of participants comprising mothers of under-five children, and healthcare workers. Results: The most common barriers in measles vaccination that emerged was fear of side effects and overworked healthcare workers, while the motivating factors were good rapport between the community and healthcare workers and communicating health-related information. One of the core themes that emerged was the need for strengthening routine immunization services. Conclusion: Tremendous efforts are taken by the public health systems and healthcare workers in the community for ensuring good quality healthcare, including routine immunization. However, establishing a good rapport and building trust among the community members is the need of the hour for ensuring a robust immunization coverage uniformly across the nation.

Estimating the health effects of COVID-19-related immunisation disruptions in 112 countries during 2020–30: a modelling study

There have been declines in global immunisation coverage due to the COVID-19 pandemic. Recovery has begun but is geographically variable. This disruption has led to under-immunised cohorts and interrupted progress in reducing vaccine-preventable disease burden. There have, so far, been few studies of the effects of coverage disruption on vaccine effects. We aimed to quantify the effects of vaccine-coverage disruption on routine and campaign immunisation services, identify cohorts and regions that could particularly benefit from catch-up activities, and establish if losses in effect could be recovered. For this modelling study, we used modelling groups from the Vaccine Impact Modelling Consortium from 112 low-income and middle-income countries to estimate vaccine effect for 14 pathogens. One set of modelling estimates used vaccine-coverage data from 1937 to 2021 for a subset of vaccine-preventable, outbreak-prone or priority diseases (ie, measles, rubella, hepatitis B, human papillomavirus [HPV], meningitis A, and yellow fever) to examine mitigation measures, hereafter referred to as recovery runs. The second set of estimates were conducted with vaccine-coverage data from 1937 to 2020, used to calculate effect ratios (ie, the burden averted per dose) for all 14 included vaccines and diseases, hereafter referred to as full runs. Both runs were modelled from Jan 1, 2000, to Dec 31, 2100. Countries were included if they were in the Gavi, the Vaccine Alliance portfolio; had notable burden; or had notable strategic vaccination activities. These countries represented the majority of global vaccine-preventable disease burden. Vaccine coverage was informed by historical estimates from WHO-UNICEF Estimates of National Immunization Coverage and the immunisation repository of WHO for data up to and including 2021. From 2022 onwards, we estimated coverage on the basis of guidance about campaign frequency, non-linear assumptions about the recovery of routine immunisation to pre-disruption magnitude, and 2030 endpoints informed by the WHO Immunization Agenda 2030 aims and expert consultation. We examined three main scenarios: no disruption, baseline recovery, and baseline recovery and catch-up. We estimated that disruption to measles, rubella, HPV, hepatitis B, meningitis A, and yellow fever vaccination could lead to 49 119 additional deaths (95% credible interval [CrI] 17 248-134 941) during calendar years 2020-30, largely due to measles. For years of vaccination 2020-30 for all 14 pathogens, disruption could lead to a 2·66% (95% CrI 2·52-2·81) reduction in long-term effect from 37 378 194 deaths averted (34 450 249-40 241 202) to 36 410 559 deaths averted (33 515 397-39 241 799). We estimated that catch-up activities could avert 78·9% (40·4-151·4) of excess deaths between calendar years 2023 and 2030 (ie, 18 900 [7037-60 223] of 25 356 [9859-75 073]). Our results highlight the importance of the timing of catch-up activities, considering estimated burden to improve vaccine coverage in affected cohorts. We estimated that mitigation measures for measles and yellow fever were particularly effective at reducing excess burden in the short term. Additionally, the high long-term effect of HPV vaccine as an important cervical-cancer prevention tool warrants continued immunisation efforts after disruption. The Vaccine Impact Modelling Consortium, funded by Gavi, the Vaccine Alliance and the Bill & Melinda Gates Foundation. For the Arabic, Chinese, French, Portguese and Spanish translations of the abstract see Supplementary Materials section.

Integration of the RTS,S/AS01 malaria vaccine into the Essential Programme on Immunisation in western Kenya: a qualitative longitudinal study from the health system perspective

Malaria accounts for over half a million child deaths annually. WHO recommends RTS,S/AS01 to prevent malaria in children living in moderate-to-high malaria transmission regions. We conducted a qualitative longitudinal study to investigate the contextual and dynamic factors shaping vaccine delivery and uptake during a pilot introduction in western Kenya. The study was conducted between Oct 3, 2019, and Mar 24, 2022. We conducted participant and non-participant observations and in-depth interviews with health-care providers, health managers, and national policymakers at three timepoints using an iterative approach and observations of practices and processes of malaria vaccine delivery. Transcripts were coded by content analysis using the consolidated framework for implementation research, to which emerging themes were added deductively and categorised into challenges and opportunities. We conducted 112 in-depth interviews with 60 participants (25 health-care providers, 27 managers, and eight policy makers). Health-care providers highlighted limitations in RTS,S/AS01 integration into routine immunisation services due to the concurrent pilot evaluation and temporary adaptations for health reporting. Initial challenges related to the complexity of the four-dose schedule (up to 24-months); however, self-efficacy increased over time as the health-care providers gained experience in vaccine delivery. Low uptake of the fourth dose remained a challenge. Health managers cited insufficient trained immunisation staff and inadequate funding for supervision. Confidence in the vaccine increased among all participant groups owing to reductions in malaria frequency and severity. Integration of RTS,S/AS01 into immunisation services in western Kenya presented substantial operational challenges most of which were overcome in the first 2 years, providing important lessons for other countries. Programme expansion is feasible with intensive staff training and retention, enhanced supervision, and defaulter-tracing to ensure uptake of all doses. PATH via World Health Organization; Gavi, the Vaccine Alliance; The Global Fund; and Unitaid.

Effect of Covid pandemic on immunization status of children in tertiary care Hospital of North India: reason for partial and non-immunization a cross-sectional study

BackgroundLow immunization coverage in India attributes to many factors including sociodemographic factors and people’s behavior. COVID-19 pandemic resulted in disruptions in achieving optimum availability and utilization of immunization services. This study was carried out to find out the immunization status of children in the post COVID era and various factors responsible for non-immunization during the pandemic.MethodsThis cross-sectional study included parents of 225 admitted children aged 1–6 years were interviewed using a semi-structured open-ended questionnaire. Children were classified as completely immunized, partially immunized and unimmunized on the basis of vaccines missed given under first year of life. Reasons for non-immunization and delay/missed vaccination during COVID-19 pandemic were recorded.ResultsOf the 225 children, 162 (72%; 95% CI 66–78%) were completely immunized, 55 (24.4%; 95% CI 19–30%) were partially immunized and 8 (3.6%; 95% CI 1–6%) were unimmunized. Parents with hospital deliveries, higher education level and lesser birth order were more likely to have children with better immunization status (p < 0.05). First dose of measles scheduled at 9 months and 3rd dose of pentavalent vaccine/OPV/Rotavirus vaccine scheduled at 14 weeks were most commonly missed vaccines among partially immunized. Lack of awareness (n = 36, 57.1%; 95% CI 45–70%) was the common reason for partial and non-immunization followed by illness of child (n = 21, 33.3%; 95% CI 21–45%) and COVID-19 pandemic (n = 11, 17.4%; 95% CI 8–27%). Pandemic was reason for delay in 50 (22.2%; 95% CI 17–28%) children. Restrictions of movement (64%; 95% CI 50–78%), fear of being exposed to COVID-19 (52%; 95% CI 38–66%) were the most common reasons for delay during the pandemic. Of the 50 children who had delay due to pandemic, 39 children (17.3%; 95% CI 12–22%) received their catch-up immunization after the pandemic. No child remained completely unimmunized due to COVID-19 pandemic.ConclusionsAlthough COVID-19 pandemic resulted in disruptions in routine immunization services, sociodemographic factors such as awareness for immunization, parental education and various beliefs for immunization were responsible for the children remaining unimmunized or partially immunized after the pandemic.

Have routine childhood vaccine administration rates reached pre-COVID-19 pandemic levels? A hospital registry-based study from North India

Background: In many nations, including India, the COVID-19 outbreak hampered routine immunization (RI) services. Information about how a lockdown affects immunization rates is available; however, there is a dearth of published information about immunization rates after the lockdown. Aims and Objectives: To study the bearing of COVID‐19 pandemic on immunization and, with the pandemic under control, to access whether India is getting back on track with its nationwide RI program. Materials and Methods: A hospital registry-based retrospective observational study was performed. Data were collected from February 2019 until June 2022. The vaccine administration rates in 2019 were considered as baseline. Comparisons of changes in vaccination rates for different periods were done using the “N-1” Chi-squared test on the online statistical software MedCalc. Results: As compared to March until May 2019, there was a decline of 27% in the administration of birth doses, a 28% decline in other doses, and a 33% decline in maternal doses of tetanus in the year 2020. From March to May 2021, birth doses showed a decline of 32% as compared to 2019, whereas other doses showed an increase of 25%. In the same months of 2022, birth doses have still not reached pre-COVID-19 levels (a decline of 10%), though administration of other doses has almost doubled. Conclusion: We thus conclude that a significant drop in RI administration rates at our immunization clinic and vaccine administration rates did not achieve pre-COVID-19 levels as of 2022.

Access to DTP-Based Combination Vaccines in Asia-Pacific Countries between 2019 and 2022.

The Asia-Pacific countries are highly diverse in health and economic conditions that may impact vaccine access and uptake. Our study aimed to characterize patterns of health access to DTP-based combination vaccines in 10 countries from 2019 to 2022 using the IQVIA-MIDAS database. The availability, affordability, and accessibility were compared across countries by national health and economic performance indicators using Spearman's rank correlation coefficient. Our findings showed that the three aspects of access to DTP-based vaccines varied substantially in the Asia-Pacific region, with higher levels in countries with better health and economic performance. Affected by the COVID-19 pandemic, vaccine accessibility fluctuates significantly in lower-income countries, with DTP coverage rates falling by more than 14% in the Philippines and Indonesia between 2019 and 2021. For availability and affordability, Singapore and Malaysia from high-income groups were largely affected, which may be related to health expenditure as a percentage of gross domestic product (Coefficient = 0.39, p = 0.03). Our study indicates that greater attention needs to be paid to national health expenditure and routine immunization services to improve vaccine disparities and increase the robustness and resilience of the vaccine supply chain during public health emergencies.

Leveraging the CORE Group Partners Project Polio Infrastructure to Integrate COVID-19 Vaccination and Routine Immunization in South Sudan.

Countries with fragile health systems like South Sudan experienced significant impacts on routine immunization during the COVID-19 pandemic. Routine immunization in children aged younger than 1 year declined due to pandemic-related constraints and was compounded by the introduction of the COVID-19 vaccine, which was met with hesitancy and reluctance. When South Sudan reported the first COVID-19 case in March 2020, the CORE Group Partners Project (CGPP) rapidly integrated the COVID-19 outbreak response into its ongoing polio eradication activities, leveraging the existing polio infrastructure and human resources. We describe the integration process, results, and challenges and detail the impact of the integration on coverage for both routine immunization and COVID-19 vaccinations. Efforts to integrate COVID-19 vaccination and routine immunization service delivery were implemented in 5 phases: assessing the need, developing multisector collaborations, developing a service delivery plan, assessing implementation readiness, and implementing and evaluating the service delivery plan. Integration efforts prioritized coordination, training vaccinators and volunteers, development of microplans, data management, and last-mile vaccine delivery. Integrated service delivery was implemented through "one-stop shop" sessions where communities accessed routine immunizations for children, COVID-19 vaccinations for adults, and other primary health services. Integrating health service delivery contributed to improved routine immunization coverage among children, improved COVID-19 vaccination coverage among adults, reduced cost for service delivery, and increased access to more comprehensive health services in hard-to-reach communities. COVID-19 vaccinations were delivered at US$4.70 per dose, a cost substantially lower than other reported delivery mechanisms. Integration can yield positive results and improve access to vaccination and other health services for communities. However, it requires clear policy guidelines, commitment, and strong collaboration. Challenges included resistance from stakeholders, overstretched human resources, and diversion of funding and attention from program areas, which were overcome through deliberate high-level advocacy, partnership, and intensified community engagement.

Understanding household-level risk factors for zero dose immunization in 82 low- and middle-income countries.

In 2021, an estimated 18 million children did not receive a single dose of routine vaccinations and constitute the population known as zero dose children. There is growing momentum and investment in reaching zero dose children and addressing the gross inequity in the reach of immunization services. To effectively do so, there is an urgent need to characterize more deeply the population of zero dose children and the barriers they face in accessing routine immunization services. We utilized the most recent DHS and MICS data spanning 2011 to 2020 from low, lower-middle, and upper-middle income countries. Zero dose status was defined as children aged 12-23 months who had not received any doses of BCG, DTP-containing, polio, and measles-containing vaccines. We estimated the prevalence of zero-dose children in the entire study sample, by country income level, and by region, and characterized the zero dose population by household-level factors. Multivariate logistic regressions were used to determine the household-level sociodemographic and health care access factors associated with zero dose immunization status. To pool multicountry data, we adjusted the original survey weights according to the country's population of children 12-23 months of age. To contextualize our findings, we utilized United Nations Population Division birth cohort data to estimate the study population as a proportion of the global and country income group populations. We included a total of 82 countries in our univariate analyses and 68 countries in our multivariate model. Overall, 7.5% of the study population were zero dose children. More than half (51.9%) of this population was concentrated in African countries. Zero dose children were predominantly situated in rural areas (75.8%) and in households in the lowest two wealth quintiles (62.7%) and were born to mothers who completed fewer than four antenatal care (ANC) visits (66.5%) and had home births (58.5%). Yet, surprisingly, a considerable proportion of zero dose children's mothers did receive appropriate care during pregnancy (33.5% of zero dose children have mothers who received at least 4 ANC visits). When controlled for other factors, children had three times the odds (OR = 3.00, 95% CI: 2.72, 3.30) of being zero dose if their mother had not received any tetanus injections, 2.46 times the odds (95% CI: 2.21, 2.74) of being zero dose if their mother had not received any ANC visits, and had nearly twice the odds (OR = 1.87, 95% CI: 1.70, 2.05) of being zero dose if their mother had a home delivery, compared to children of mothers who received at least 2 tetanus injections, received at least 4 ANC visits, and had a facility delivery, respectively. A lack of access to maternal health care was a strong risk factor of zero dose status and highlights important opportunities to improve the quality and integration of maternal and child health programs. Additionally, because a substantial proportion of zero dose children and their mothers do receive appropriate care, approaches to reach zero dose children should incorporate mitigating missed opportunities for vaccination.

Trends in Vaccine Completeness in Children Aged 0-23 Months in Cape Town, South Africa.

We have previously determined that the occurrence of missed vaccination opportunities in children in Cape Town, South Africa, is shaped by both individual and contextual factors. These factors present valuable openings for enhancing quality and implementing broader strategies to enhance the delivery of routine Immunisation services. Here, we are further reporting regional-level data on the coverage and factors influencing vaccination completion within a similar study population, based on extensive data analysis from the 2016 South African Demographic and Health Survey. The study reveals commendable vaccination coverage for most vaccines within recommended schedules, with high rates of initial vaccinations at birth and during the primary vaccination schedule. However, there are notable areas for improvement, particularly in ensuring complete coverage for the second measles vaccine and the 18-month vaccine. Socio-demographic factors also play a role, with maternal education and caregiver awareness campaigns showing the potential to positively influence vaccination completeness. This study emphasises the importance of timely vaccinations during the early months of life and underscores the need for interventions to maintain coverage as children age. Specific sub-districts, such as Tygerberg, may require targeted efforts to enhance vaccination completeness. Additionally, assessing caregiver knowledge about child vaccination is deemed vital, as it can impact vaccination decisions and adherence. The findings provide valuable insights for public health interventions in Cape Town, aimed at reducing the burden of vaccine-preventable diseases and ensuring the health of the region's youngest population.

Missed opportunities: Reducing zero dose children among the urban poor after COVID, Mumbai India, 2022

Reaching urban poor populations poses challenges for equitable immunization coverage. Furthermore, COVID disrupted routine immunization services. In Mumbai, India, first dose diphtheria tetanus pertussis containing vaccine (DTPCV1)coverage dropped from 88% (2019) to 76% (2021).We identified and characterized 125 zero-dose (those withoutDTPCV1)migrant children in urban Mumbai in October 2022.Almost half were born elsewhere than Mumbai; 53% resided at their present location for less than a year. More than half were 12–59 months of age, well-beyond the age for first routine childhood immunizations.Three of four zero dose children had received birth dose vaccination in the hospital; but failed to receive DTPCV1. Vaccine hesitancy, awareness gaps and operational issues were common reasons for non-vaccination. Despite frequent visits to health facilities for illness,only a third of facility staff asked or advised parents about vaccination.Missed opportunities were much more common in private than government facilities.For the vast majority (88%), residential sites were included in local routine immunization micro-plans and distances to immunization sites were short (less than 1 km for 94 % of families).However, planned session frequency was inadequate half of the time.Expanded efforts to reach migrant urban poor children are needed to ensure vaccine equity.

Resilience of routine childhood immunization services in two counties in Kenya in the face of the COVID-19 pandemic

The recently emerged coronavirus disease 2019 (COVID-19) has caused considerable morbidity and mortality worldwide and disrupted health services. We describe the effect of the COVID-19 pandemic on utilization of childhood vaccination services during the pandemic. Using a mixed methods approach combining retrospective data review, a cross-sectional survey, focus group discussions among care givers and key informant interviews among nurses, we collected data between May and September 2021 in Mombasa and Nakuru counties. Overall, there was a <2 % decline in the number of vaccine doses administered during the pandemic period compared to the pre-pandemic period but this was statistically insignificant, both for the pentavalent-1 vaccine (ß = −0.013, p = 0.505) and the pentavalent-3 vaccine (ß = −0.012, p = 0.440). In government health facilities, there was 7.7 % reduction in the number of pentavalent-1 (ß = −0.08, p = 0.010) and 10.4 % reduction in the number of pentavalent-3 (ß = −0.11, p < 0.001) vaccine doses that were administered during the pandemic period. In non-government facilities, there was a 25.8 % increase in the number of pentavalent-1 (ß=0.23, p < 0.001) and 31.0 % increase in the number of pentavalent-3 (ß = −0.27, p < 0.001) vaccine doses that were administered facilities during the pandemic period. The strategies implemented to maintain immunization services during the pandemic period included providing messaging on the availability and importance of staying current with routine vaccination and conducting catch-up vaccinations and vaccination outreaches. Our findings suggest that the COVID-19 pandemic did not impact childhood vaccination services in Mombasa and Nakuru counties in Kenya. The private health facilities cushioned vaccination services against the effects of the pandemic and the strategies that were put in place by the ministry of health ensured continuation of vaccination services and encouraged uptake of the services during the pandemic period in the two counties in Kenya. These findings provide useful information to safeguard vaccination services during future pandemics.

A case series of substance abuse among urban slum population during the COVID 19 pandemic.

The COVID 19 pandemic stuck the world already burdened with numerous diseases. The approach toward controlling the pandemic disturbed the healthcare delivery system and also aggravated the already existing problems of malnutrition, unemployment, economic inequalities, decreased routine immunization services, and substance abuse. Six individuals with multiple substance use histories were identified and in depth interviews were conducted in an urban slum under the field practice area of a medical college. Common features were identified and reported. The age of initiation of alcohol and tobacco use was found to be in the early adolescence period (10-14 years). Chronic substance abuse causes poor health, an economic burden on families, and domestic violence. Lack of self esteem due to unemployment, decreased social interaction, and multiple failed attempts at abstinence were the shared features among dependents. Measures employed during the COVID 19 pandemic to contain the virus have caused unanticipated adverse effects on health, finance, and social life. A holistic approach would play a pivotal role rather than reactionary and momentary interventions.

Introducing seasonal influenza vaccine in Bhutan: Country experience and achievements

Bhutan successfully introduced multiple vaccines since the establishment of the Vaccine Preventable Disease Program in 1979. Surveillance and subsequent introduction of influenza vaccination became a public health priority for the Ministry of Health following the influenza A(H1N1)pdm09 pandemic. Sentinel surveillance for influenza in Bhutan began in 2008, and a study of severe acute respiratory infection was conducted in 2017, which found the highest influenza burden in children aged <5 years and adults ≥50 years. Following review of surveillance and burden of disease data, the National Technical Advisory Group presented recommendations to Bhutan’s Ministry of Health which approved influenza vaccine introduction for all five high-risk groups in the country. Upon the official launch of the program in June 2018, the Vaccine Preventable Disease Program began planning, budgeting, and procurement processes with technical and financial support from the Partnership for Influenza Vaccine Introduction, the United States Centers for Disease Control and Prevention, the Bhutan Health Trust Fund, and the World Health Organization. Influenza vaccination for high-risk groups was integrated into Bhutan’s routine immunization services in all health care facilities beginning in November 2019 and vaccinated all populations in 2020 in response to the COVID-19 pandemic. Coverage levels between 2019 and 2022 were highest in children aged 6–24 months (62.5%–96.9%) and lowest in pregnant women (47.7%–62.5%). Bhutan maintained high coverage levels despite the COVID-19 pandemic by continued provision of influenza vaccine services at health centers during lockdowns, conducting communication and sensitization efforts, and using catch-up campaigns. Bhutan’s experience with introducing and scaling up the influenza vaccine program contributed to the country’s capacity to rapidly deploy its COVID-19 vaccination program in 2021.