National Routine Immunization Research Articles

Trade-offs of different poliovirus vaccine options for outbreak response in the United States and other countries that only use inactivated poliovirus vaccine (IPV) in routine immunization

Delays in achieving polio eradication have led to ongoing risks of poliovirus importations that may cause outbreaks in polio-free countries. Because of the low, but non-zero risk of paralysis with oral poliovirus vaccines (OPVs), countries that achieve and maintain high national routine immunization coverage have increasingly shifted to exclusive use of inactivated poliovirus vaccine (IPV) for all preventive immunizations. However, immunization coverage within countries varies, with under-vaccinated subpopulations potentially able to sustain transmission of imported polioviruses and experience local outbreaks. Due to its cost, ease-of-use, and ability to induce mucosal immunity, using OPV as an outbreak control measure offers a more cost-effective option in countries in which OPV remains in use. However, recent polio outbreaks in IPV-only countries raise questions about whether and when IPV use for outbreak response may fail to stop poliovirus transmission and what consequences may follow from using OPV for outbreak response in these countries. We systematically reviewed the literature to identify modeling studies that explored the use of IPV for outbreak response in IPV-only countries. In addition, applying a model of the 2022 type 2 poliovirus outbreak in New York, we characterized the implications of using different OPV formulations for outbreak response instead of IPV. We also explored the hypothetical scenario of the same outbreak except for type 1 poliovirus instead of type 2. We find that using IPV for outbreak response will likely only stop outbreaks for polioviruses of relatively low transmission potential in countries with very high overall immunization coverage, seasonal transmission dynamics, and only if IPV immunization interventions reach some unvaccinated individuals. Using OPV for outbreak response in IPV-only countries poses substantial risks and challenges that require careful consideration, but may represent an option to consider for some outbreaks in some populations depending on the properties of the available vaccines and coverage attainable.

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.

Penyuluhan Tentang Imunisasi Dasar Lengkap Pada Ibu Balita

Introduction Complete national routine immunization coverage is currently slowly increasing again after the COVID pandemic from 84% in 2019 to 94.9% in 2022. Indonesian children have been immunized. This increase was given a good score but not enough, because there are still around 5% or 240,000 Indonesian children who have not received additional protection from complete basic immunization, meaning these children are still at high risk of contracting diseases that can be prevented by immunization (PD3I). The Ministry of Health targets 100 percent of babies to receive complete basic immunization (IDL) by 2023. This community service aims to provide knowledge to mothers of toddlers about complete basic immunization (0 to 11 months). This service method takes the form of counseling and giving leaflets to mothers of toddlers. This community service activity was carried out at Latulip Posyandu, Layana Village, Talise Health Center working area on June 21 2023. The target audience for this community service activity was all mothers with toddlers who live in Layana Village as the Talise Health Center Working Area, 18 mothers of toddlers. The results of the activity were the knowledge of mothers of toddlers about complete basic immunization after counseling, namely the majority with good knowledge, 15 participants (83.3%) and 3 participants (16.7%) with sufficient knowledge. The conclusion is that this community service activity can provide understanding to mothers of toddlers about complete basic immunization. Suggestions to the Talise Community Health Center to continue to increase community knowledge and provide motivation for mothers of toddlers to support the success of achieving complete basic immunization coverage according to the national target of 100 percent.

Rotavirus vaccine product switch in Ghana: An assessment of service delivery costs, switching costs, and cost-effectiveness.

Ghana introduced rotavirus vaccine (ROTARIX 1-dose presentation) into the routine national immunization program in 2012 and switched to a different product (ROTAVAC 5-dose presentation) in 2020. ROTAVAC has a lower price per dose (US$0.85 versus US$2.15 for ROTARIX) and smaller cold chain footprint but requires more doses per regimen (three versus two). This study estimates the supply chain and service delivery costs associated with each product, the costs involved in switching products, and compares the cost-effectiveness of both products over the next ten years. We estimated the supply chain and service delivery costs associated with ROTARIX and ROTAVAC (evaluating both the 5-dose and 10-dose presentations) using primary data collected from health facilities in six of the 14 regions in the country. We estimated the costs of switching from ROTARIX to ROTAVAC using information collected from key informant interviews and financial records provided by the government. All costs were reported in 2020 US$. We used the UNIVAC decision-support model to evaluate the cost-effectiveness (US$ per disability-adjusted life-year (DALY) averted from government and societal perspectives) of ROTARIX and ROTAVAC (5-dose or 10-dose presentations) compared to no vaccination, and to each other, over a ten-year period (2020 to 2029). We ran probabilistic sensitivity analyses and other threshold analyses. The supply chain and service delivery economic cost per dose was $2.40 for ROTARIX, $1.81 for ROTAVAC 5-dose, and $1.76 for ROTAVAC 10-dose. The financial and economic cost of switching from ROTARIX to ROTAVAC 5-dose was $453,070 and $883,626, respectively. Compared to no vaccination, the cost per DALY averted was $360 for ROTARIX, $298 for ROTAVAC 5-dose, and $273 for ROTAVAC 10-dose. ROTAVAC 10-dose was the most cost-effective option and would be cost-effective at willingness-to-pay thresholds exceeding 0.12 times the national GDP per capita ($2,206 in the year 2020). The switch from ROTARIX to ROTAVAC 5-dose in 2020 was cost-saving. Rotavirus vaccination is highly cost-effective in Ghana. A switch from ROTAVAC 5-dose to ROTAVAC 10-dose would be cost-saving and should be considered.

Studying Vaccination Coverage and Design of Short Message Service Based Reminder to Improve Children Vaccination Coverage in Hawassa; Sidama Region; Ethiopia

A vaccine is a kind of remedy that trains the body’s protection system so that it can combat an infection. The national routine immunization coverage in Ethiopia is low. Among the main reason for defaulting children vaccinations are disremembering the appointment date, communication gap between service providers and the community, knowhow about vaccination and etc. This work is to investigate vaccination coverage in Hawassa city and main reasons of vaccination drop out, and then provide a solution for that main reason. Data was collected from 360 children whose age is between 1 to 2 years who live in Hawassa city. The data analysis result showed that only 51% of the children are fully vaccinated; and the main reason for vaccination dropout which weighs 57% was found to be disremembering the appointment date. Providing a solution to not only one of the main reasons but also for the one which weighs the most in the city of this study will improve the vaccination coverage. As the main reason is found to be disremembering the vaccination appointment date, this work provides a Short Message Service (SMS) based automatic reminding system. The design part uses database, OzekiNG network gateway and global system for mobile communication modem with active subscriber identity module. In this system the health extension workers will register the clients’ detailed information including appointment dates during the birth of baby that will be accessed periodically by the OzekiNG to send the reminder SMS to the mothers one day a head to the day of vaccination. After automatic reminding mechanism was developed and implemented, coverage of fully vaccinated children increases from 51% to 71% and the problem of forgetting appointment date decreases from 57% to 14%. The efficiency of the developed system is found to be 85%. From the above-mentioned results and the current available communication mechanisms, it can be concluded that the reminding system can be simply implemented to improve the child vaccination coverage by bridging the gap due to disremembering the vaccination appointment date.

Studying Vaccination Coverage and Design of Short Message Service Based Reminder to Improve Children Vaccination Coverage in Hawassa; Sidama Region; Ethiopia

A vaccine is a kind of remedy that trains the body’s protection system so that it can combat an infection. The national routine immunization coverage in Ethiopia is low. Among the main reason for defaulting children vaccinations are disremembering the appointment date, communication gap between service providers and the community, knowhow about vaccination and etc. This work is to investigate vaccination coverage in Hawassa city and main reasons of vaccination drop out, and then provide a solution for that main reason. Data was collected from 360 children whose age is between 1 to 2 years who live in Hawassa city. The data analysis result showed that only 51% of the children are fully vaccinated; and the main reason for vaccination dropout which weighs 57% was found to be disremembering the appointment date. Providing a solution to not only one of the main reasons but also for the one which weighs the most in the city of this study will improve the vaccination coverage. As the main reason is found to be disremembering the vaccination appointment date, this work provides a Short Message Service (SMS) based automatic reminding system. The design part uses database, OzekiNG network gateway and global system for mobile communication modem with active subscriber identity module. In this system the health extension workers will register the clients’ detailed information including appointment dates during the birth of baby that will be accessed periodically by the OzekiNG to send the reminder SMS to the mothers one day a head to the day of vaccination. After automatic reminding mechanism was developed and implemented, coverage of fully vaccinated children increases from 51% to 71% and the problem of forgetting appointment date decreases from 57% to 14%. The efficiency of the developed system is found to be 85%. From the above-mentioned results and the current available communication mechanisms, it can be concluded that the reminding system can be simply implemented to improve the child vaccination coverage by bridging the gap due to disremembering the vaccination appointment date.

Studying Vaccination Coverage and Design of Short Message Service Based Reminder to Improve Children Vaccination Coverage in Hawassa; Sidama Region; Ethiopia

A vaccine is a kind of remedy that trains the body’s protection system so that it can combat an infection. The national routine immunization coverage in Ethiopia is low. Among the main reason for defaulting children vaccinations are disremembering the appointment date, communication gap between service providers and the community, knowhow about vaccination and etc. This work is to investigate vaccination coverage in Hawassa city and main reasons of vaccination drop out, and then provide a solution for that main reason. Data was collected from 360 children whose age is between 1 to 2 years who live in Hawassa city. The data analysis result showed that only 51% of the children are fully vaccinated; and the main reason for vaccination dropout which weighs 57% was found to be disremembering the appointment date. Providing a solution to not only one of the main reasons but also for the one which weighs the most in the city of this study will improve the vaccination coverage. As the main reason is found to be disremembering the vaccination appointment date, this work provides a Short Message Service (SMS) based automatic reminding system. The design part uses database, OzekiNG network gateway and global system for mobile communication modem with active subscriber identity module. In this system the health extension workers will register the clients’ detailed information including appointment dates during the birth of baby that will be accessed periodically by the OzekiNG to send the reminder SMS to the mothers one day a head to the day of vaccination. After automatic reminding mechanism was developed and implemented, coverage of fully vaccinated children increases from 51% to 71% and the problem of forgetting appointment date decreases from 57% to 14%. The efficiency of the developed system is found to be 85%. From the above mentioned results and the current available communication mechanisms, it can be concluded that the reminding system can be simply implemented to improve the child vaccination coverage by bridging the gap due to disremembering the vaccination appointment date.

Pattern of bacteriological and biochemical profile and determinants of metabolic acidosis among under-fives with diarrheal diseases at the diarrhea treatment and training unit of the University of Calabar Teaching Hospital, Calabar, Nigeria

Objectives: Dehydration and electrolyte derangements are major causes of morbidity and mortality in diarrhea disease. We aimed to evaluate the pattern and determinants of electrolyte derangements and isolates in a stool sample of under-fives with diarrhea at a tertiary hospital in Nigeria. Materials and Methods: This was a prospective and cross-sectional study of 136 under-fives admitted into the diarrheal training and treatment unit who were consecutively recruited. Patients were tested for association using Pearson’s Chi-square, Kruskal–Wallis’ test, and logistic regression modeling. Results: A total of 136 babies were recruited. Three of the stool sample were culture positive for non-specified Escherichia coli, another two grew Entamoeba histolytica. Almost half (n = 56/136, 41.2%) of the children had metabolic acidosis. Predictors of acidosis included severe dehydration (adjOR: 5.76, 95%CI: 1.54–21.50, P = 0.009), ≤3 months breastfeeding (AdjOR 0.39, 95%CI: 0.153–0.997, P = 0.049), and fever (adjOR 6.30, 95%CI: 1.74–22.83, P = 0.005). Conclusion: Metabolic acidosis was common with diarrhea for which exclusive breastfeeding was protective in this study. Although few, the growth of E. histolytica implicates sanitary conditions and suggests the viral origin of diarrhea, hence strongly supports the introduction of rotavirus vaccine in our national routine immunization schedule while proper use of ORS may impact positively on the metabolic complication of diarrheal disease in the tropics.

RTS,S/AS01 malaria vaccine (Mosquirix®): a profile of its use.

RTS,S/AS01 (Mosquirix®) is a vaccine against malaria caused by Plasmodium falciparum. In a phase 3 trial, RTS,S/AS01 showed vaccine efficacy against clinical malaria, severe malaria and malaria hospitalization, with an acceptable safety and tolerability profile, in children aged 6 weeks to 17 months; the vaccine efficacy was greater in children than in infants and waned over time. In another phase 3 trial, RTS,S/AS01 was noninferior to seasonal malaria chemoprevention in children. WHO recommends a 4-dose schedule of RTS,S/AS01 for the prevention of P. falciparum malaria in children from 5 months of age living in regions with moderate to high malaria transmission, with an optional 5-dose schedule for areas with highly seasonal malaria transmission. First results from large pilot implementation in Africa show that RTS,S/AS01 has a favourable safety profile, increases equity in access to malaria prevention, is highly cost effective, can be delivered through routine national immunization programmes and substantially reduces severe malaria burden.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40267-022-00937-3.

Attitudes and behaviors of obstetricians and gynecologists toward HPV vaccination: a 7-year follow-up survey in Japan.

In Japan, the government suspended HPV vaccine recommendation in 2013, resulting in dropping vaccination uptake to almost zero. We conducted four serial surveys on our colleague' attitude to HPV vaccination between 2014 and 2021. Here, we evaluate the result of the survey in 2021 and compare it to previous surveys. The subjects were 567 obstetricians and gynecologists who had been trained in our university hospital or our affiliated hospitals. We used a questionnaire similar in format to those used in 2014, 2017, and 2019. A total of 340 doctors (60.0%) completed the survey. Among them, 93.2% (317/340) of respondents thought that the government should restart HPV vaccination recommendation, and that 63.2% (215/340) think male teenagers should also vaccinate against HPV. The percentage of teenaged daughters inoculated with HPV vaccination after Japanese government had suspended its recommendation was 43.5% (20/46), an increasing trend from the previous surveys. 39 out of the 46 daughters (84.8%) would be expected to receive full HPV vaccination after they take junior high school entrance examination or after 9-valent HPV vaccination is designated as a national routine-immunization. This study revealed increasing number of our colleagues think HPV vaccination is necessary for prevention of cervical cancer. The Japanese government's decision to resume its recommendation of the HPV vaccine in November 2021 will lead to a change in the public's thinking and behavior toward the HPV vaccine.

Assessing the safety, impact and effectiveness of RTS,S/AS01E malaria vaccine following its introduction in three sub-Saharan African countries: methodological approaches and study set-up

BackgroundFollowing a 30-year development process, RTS,S/AS01E (GSK, Belgium) is the first malaria vaccine to reach Phase IV assessments. The World Health Organization-commissioned Malaria Vaccine Implementation Programme (MVIP) is coordinating the delivery of RTS,S/AS01E through routine national immunization programmes in areas of 3 countries in sub-Saharan Africa. The first doses were given in the participating MVIP areas in Malawi on 23 April, Ghana on 30 April, and Kenya on 13 September 2019. The countries participating in the MVIP have little or no baseline incidence data on rare diseases, some of which may be associated with immunization, a deficit that could compromise the interpretation of possible adverse events reported following the introduction of a new vaccine in the paediatric population. Further, effects of vaccination on malaria transmission, existing malaria control strategies, and possible vaccine-mediated selective pressure on Plasmodium falciparum variants, could also impact long-term malaria control. To address this data gap and as part of its post-approval commitments, GSK has developed a post-approval plan comprising of 4 complementary Phase IV studies that will evaluate safety, effectiveness and impact of RTS,S/AS01E through active participant follow-up in the context of its real-life implementation.MethodsEPI-MAL-002 (NCT02374450) is a pre-implementation safety surveillance study that is establishing the background incidence rates of protocol-defined adverse events of special interest. EPI-MAL-003 (NCT03855995) is an identically designed post-implementation safety and vaccine impact study. EPI-MAL-005 (NCT02251704) is a cross-sectional pre- and post-implementation study to measure malaria transmission intensity and monitor the use of other malaria control interventions in the study areas, and EPI-MAL-010 (EUPAS42948) will evaluate the P. falciparum genetic diversity in the periods before and after vaccine implementation.ConclusionGSK’s post-approval plan has been designed to address important knowledge gaps in RTS,S/AS01E vaccine safety, effectiveness and impact. The studies are currently being conducted in the MVIP areas. Their implementation has provided opportunities and posed challenges linked to conducting large studies in regions where healthcare infrastructure is limited. The results from these studies will support ongoing evaluation of RTS,S/AS01E’s benefit-risk and inform decision-making for its potential wider implementation across sub-Saharan Africa.Graphic abstract

Impact of a two-dose varicella immunization program on the incidence of varicella: a multi-year observational study in Shanghai, China

ABSTRACT Background It remains hesitant to include a two-dose varicella vaccine (VarV) in a national routine immunization program in China. We aimed to quantify the impact of the two-dose VarV on varicella incidence in Shanghai. Research design and methods We directly extracted the data of varicella cases and VarV doses in 2013–2020 in Shanghai, and then estimated the effects of two-dose VarV using a Serfling model. Results A two-dose VarV immunization program has been extensively implemented since October 2017 and become free since August 2018 in Shanghai. Before and after this program, varicella cases significantly declined in children (P < 0.01), whereas did not in adults aged >18 years (P = 0.22). Compared to the predicted number of varicella cases, actual number was significantly lower by 8% in 2018 and 28% in 2019. Among children aged 4–6 years, the reduction in varicella cases was largest. Moreover, there was a significant reduction in varicella cases throughout 2020 (P < 0.001), in which the decrease due to social distancing for the COVID-19 was 54%. Conclusions A two-dose VarV immunization program may further reduce approximately one-third of varicella cases in Shanghai. Children <4 years and adults benefit less in this program, which warrants enhancing the immunization.

Efforts Towards Polio Eradication in Madagascar: 1997 to 2017.

BackgroundIn 1988, the World Health Assembly launched the Global Polio Eradication Initiative. WHO AFRO is close to achieve this goal with the last wild poliovirus detected in 2014 in Borno States in Nigeria. The certification of the WHO African Region requires that all the 47 member states meet the critical indicators for a polio free status. Madagascar started implementing polio eradication activities in 1996 and was declared polio free in June 2018 in Abuja. This study describes the progress achieved towards polio eradication activities in Madagascar from 1977-2017 and highlights the remaining challenges to be addressed.MethodsData were collected from the national routine immunization services, Country Acute Flaccid surveillance databases and national reports of SIAS and Mop Up campaign. Country complete polio and immunization related documentation provided detailed historical information’s.ResultsFrom 1997 to 2017, Madagascar reported one wild poliovirus (WPV) outbreak and four circulating Vaccine Derived Polio Virus (cVDPV) oubreaks with a total of 21 polioviruses (1 WPV and 21 cVDPV). The last WPV and cVDPV were notified in 1997 in Antananarivo and 2015 in Sakaraha health districts respectively. Madagascar met the main polio surveillance indicators over the last ten years and made significant progress following the last cVDPV2 outbreak in 2014 -2015. In addition, the country successfully implemented the switch from trivalent Oral Polio Vaccine (tOPV) to bivalent Oral Polio vaccine (bOPV) and containment activities. Environmental Surveillance established since 2015 did not reveal any poliovirus. The administrative coverage of the 3rd dose of oral polio vaccine (OPV3) varied across the years from 55% in 1991 to a maximum of 95% in 2007 before a progressive decrease to 86% in 2017. The percentage of AFP cases with more than 3 doses of oral polio vaccines increased from 56% in 2014 to 88% in 2017. A total of 19 supplementary immunization activities (SIA) were conducted in Madagascar from 1997 to 2017, among which 3 were subnational immunization days (sNID) and 16 were national immunization days (NIDs). Poor routine coverage contributed to the occurrence of cVDPC outbreaks in the country; addressing this should remain a key priority for the country to maintain the polio free status.From 2015 to June 2017, Madagascar achieved the required criteria leading to the acceptance of the country’s polio-free documentation in June 2018 by ARCC. However, continuous efforts will be needed to maintain a highly sensitive polio surveillance system with emphasis on security compromised areas. Finally strengthening the health system and governance at all levels will be necessary if these achievements are to be sustained.ConclusionsHigh national political commitment and support of the Global Polio Eradication Partnership were critical for Madagascar to achieve polio free status. Socio-political instability, weakness of the health system, sub-optimal routine immunization performance, insufficient SIA quality and existing security compromised areas remain critical program challenges to address in order to maintaining the polio free status. Continuous high-level advocacy should be kept in order to ensure that new government authorities maintain polio eradication among the top priorities of the country.

Interrupted time-series analyses of routine vaccination program for elderly pneumonia patients in Japan; an ecological study using aggregated nationwide inpatient data

ABSTRACT A national routine pneumococcal pneumonia immunization program started in Japan in 2014. It targeted the population aged ≥65 years and used a 23-valent pneumococcal polysaccharide vaccine; PPSV23. However, its effectiveness was not well defined because of the lack of a comprehensive database on the PPSV23 vaccination status of each subject. We used interrupted time-series analyses to assess the changes in the incidence and prognosis of elderly patients hospitalized for pneumonia before and after initiation of the program. First, we estimated the PPSV23 coverage rates in subjects aged ≥65 years based on the number of shipped PPSV23 syringes and the estimated population in each prefecture. The estimated coverage rates reached around 40% in 2014 for the 3 Tohoku prefectures, while those in the other prefectures remained below 20%. After the national routine immunization program started, the estimated coverage rate increased significantly in every prefecture and exceeded 40% in 2017. Next, we aggregated the data extracted from the Japanese Diagnosis Procedure Combination database from April 2011 through February 2017 for hospitalized pneumonia patients aged ≥65 years. The data included data from 655,746 patients, excluding those in the 3 Tohoku prefectures. Interrupted time-series analyses found no change in the incidence of hospitalized pneumonia patients and in-hospital mortality after the vaccination program, but there was a decrease in the in-hospital mortality of pneumonia patients with severe comorbidities defined by the modified Charlson comorbidity index. These results suggest an association between the vaccination program and an improved outcome in hospitalized elderly pneumonia patients with severe comorbidities in Japan.

Ensuring accountability in implementation of supplementary immunisation activities: A case study of the 2017/2018 measles vaccination campaign in Nigeria

IntroductionGlobally, there is a growing concern with accountability and health systems. This has been attributed majorly to discontent with health system performance. Within the Nigerian health system, weak accountability has been consistently singled out as a key challenge underpinning the poor performance of the immunisation programme. In preparation for the 2017/2018 Measles Vaccination Campaign in Nigeria, the National Measles Technical Coordinating Committee (NMTCC) was inaugurated with one of its key mandates being to ensure accountability in the conduct of the 2017/2018 MVC. This paper aims to share the innovative measures applied in the 2017/2018 Measles MVC to improve accountability and to highlight the contribution of the accountability framework to improving measles vaccination coverage. MethodsWe identified gaps in accountability from the post-campaign coverage reports and reviews of previous campaigns. We adapted an accountability framework developed by the Nigeria National Routine Immunization Strategic Plan (2013–2015),- which cuts across all levels. Selected indicators were used to monitor the implementation of the framework. Administrative actions such as sanctions and rewards were taken as necessary. FindingsWe found that the implementation of the accountability framework was highly instrumental in achieving a high level of coordination among all stakeholders and to improving efficient utilization of resources. We also found that the implementation of the accountability framework in the 2017/2018 MVC contributed to the improved performance of states in terms of measles vaccination coverage compared to the 2015/2016 campaign. ConclusionWe have demonstrated that the implementation of the accountability framework in the 2017/2018 MVC led to a considerable reduction in the misuse and abuse of resources and also contributed to remarkable improvement in the measles vaccination coverages across states compared to the 2015/2016 MVC.

Sero-Prevalence of Anti-Rubella IgG Antibody (Immunity) Among Pregnant Women in Rogo, a Semi-Urban Community of Kano State, North Western Nigeria

Rubella virus infection (RVI) is, in most cases, a mild disease, but can cause severe defects in developing fetus and new born known as congenital rubella syndrome (CRS) from maternal infection during pregnancy. Rubella remains poorly controlled in many poor-resourced areas (Nigeria inclusive) despite being a vaccine preventable disease. The study aimed to assess the sero-prevalence of anti-rubella IgG antibody (immunity) and level of susceptibility and associated risk factors to rubella virus infection (RVI) among unimmunized pregnant women in a sub-urban setting. It was a hospital-based, cross-sectional descriptive study, conducted in a public general hospital in Rogo, a sub-urban community located in Kano State, Northwest, Nigeria. A total of 174 consented pregnant women [age range, 13-39 years; mean age, 22.3 ± (SD 2.1) years] attending antenatal care (ANC) clinic of a secondary healthcare centre from July to December, 2017 were randomly selected for the study. Information on bio-data, socio-demographic/risk factors and medical history related to previous RVI were obtained via structured questionnaires and hospital records respectively. Blood sample was collected from each study participant and tested for anti-rubella IgG antibody (past exposure) using ELISA technique. Data were analyzed using SPSS statistical software package version 15.0 and Pearson’s Chi-square or Fisher exact test was used for statistical analysis where applicable. A P-value ≤ 0.05 was considered statistically significant. The sero-prevalence of anti-rubella IgG antibody was 93.6% (163 of 174); and rate of susceptibility to RVI among the study population was 6.4% (11 of 174) and were predominant among the study subjects between ages 16 and 25 years in their first trimester of pregnancy. A significant association exists (P<0.05) between parity (P=0.0021) and history of miscarriage or premature birth (P=0.003) and anti-rubella IgG antibody. Similarly, there is an association between sero-negative IgG antibody and parity (P=0.0021) including occupation (subjects in this category were mainly housewives) (P=0.00541) of the study participants. The high rate of rubella exposure by the study participants indicates the presence and high endemicity of rubella infection in the study area, coupled with significant level of susceptibility to RVI by the study subjects. Hence, there is need for adoption of potent rubella vaccine into the routine national immunization programme to limit the spread of RVI and associated complications and clinical sequelae among the populace.

Grounding evaluation design in the socio-ecological model of health: a logic framework for the assessment of a national routine immunization communication initiative in Kyrgyzstan

Childhood routine immunization (RI) is a highly effective public health intervention for the prevention of infectious diseases. Despite high immunization rates, a 2018 Knowledge, Attitudes, and Practices (KAP) study by the United Nations Children's Fund (UNICEF) noted a growing practice of vaccine refusal among parents and primary caregivers as well as clusters of significantly lower immunization coverage in some provinces. Moreover, a 2018 Joint Appraisal report by GAVI (Global Vaccine Alliance) has highlighted a decrease in immunization rates among children under 1 year of age from 96.1% to 92% for some vaccines. As a result, UNICEF is spearheading a national communication initiative to increase the rates of RI in Kyrgyzstan. This initiative includes strengthening interpersonal communication skills of local healthcare workers, improving the quality and accuracy of media coverage via a tailored outreach to the Kyrgyz media, as well as fostering community engagement to give voice to local champions and engage hesitant parents and vaccine refuters. UNICEF has also partnered with a research team for the design phase of a suitable evaluation framework. Grounded in the socio-ecological model (SEM) of health, the framework recognizes the interconnection of behavioral, social, and policy change, and includes not only activity-specific indicators (process indicators) but also progress, outcome, and impact indicators to document results among key groups and stakeholders at different levels of the SEM, and, ultimately, on immunization rates in Kyrgyzstan. The framework reflects the importance of an integrated and multilevel approach to intervention and communication design, and integrates the SEM with a logic model that connects different components of the initiative. This paper introduces this evaluation framework, including implications for the evaluation of child health programs, and other public health, communication, and international development interventions.

Evidence of rotavirus vaccine impact in sub-Saharan Africa: Systematic review and meta-analysis.

BackgroundOver 34 countries in Africa have introduced rotavirus vaccine to their national immunization programs: monovalent (Rotarix®, RV1) and pentavalent (RotaTeq®, RV5) after South Africa introduced it in 2009. Since then several studies assessing the impact of the vaccine have been conducted. The principal aim of this study was to evaluate the impact of rotavirus vaccine in sub-Saharan Africa.MethodsA Literature search was performed using Mendeley, PubMed, ScienceDirect, grey literature and Web of Science databases of published studies from January 1, 2017, as years of recent publications on rotavirus vaccine impact in sub-Saharan Africa. A meta-analysis was conducted for rotavirus infection in children under 5 years using proportions of pre and post-vaccine introduction in these populations. Random-effect estimates were considered since the samples were from universal populations.ResultsOut of the 935 articles identified, 17 studies met the inclusion for systematic review and meta-analysis. The pooled proportion for pre-vaccination period was 42%, 95% (CI: 38–46%), and reduced to 21%, 95% (CI: 17–25%) during post-vaccination period. Rotavirus diarrhea significantly reduced in children < 12 months as compared to children 12–24 months old. Seasonal peaks of rotavirus diarrhea were between June–September. However, data is limited to one year of post-vaccine introduction, and bias may present due to early vaccine impact.ConclusionWe observed that the introduction of the rotavirus vaccine was partly responsible for the significant reduction in the burden of rotavirus-associated diarrhea in sub-Saharan Africa. Therefore, there is a need to encourage the remaining countries to introduce the vaccine to their routine national immunization programs.

The impact of a prolonged ebola outbreak on measles elimination activities in Guinea, Liberia and Sierra Leone, 2014-2015.

IntroductionGuinea, Sierra Leone and Liberia have attained significant reduction in measles incidence between 2004 and 2013. The Ebola outbreak in 2014-2015 in West Africa caused significant disruption of the health service delivery in the three worst affected countries. The magnitude of the impact on the immunization program has not been well documented.MethodsWe reviewed national routine immunization administrative coverage data as well as measles surveillance performance and measles epidemiology in the years before, during and after the EVD outbreak in Guinea, Liberia, Sierra Leone.ResultsBoth Liberia and Guinea experienced a sharp decline of more than 25% in the monthly number of children vaccinated against measles in 2014 and 2015 as compared to the previous years, while there was no reported decline in Sierra Leone. Guinea and Liberia experienced a decline in measles surveillance activity and performance indicators in 2014 and 2015. During this period, there was an increase in measles incidence and a decline in the mean age of measles cases reported in Liberia and Sierra Leone. Guinea started reporting high measles incidence in 2016. All three countries organized measles supplemental immunization activities by June 2015. Liberia achieved 99% administrative coverage, while Guinea and Sierra Leone attained 90.6% and 97.2% coverage respectively. There were no severe adverse events reported during these mass vaccination activities. The disruptive effect of the Ebola outbreak on immunization services was especially evident in Guinea and Liberia. Our review of the reported administrative vaccination coverage at national level does not show significant decline in measles first dose vaccination coverage in Sierra Leone as compared to other reports. This may be due to inaccuracies in coverage monitoring and data quality problems. The increases in measles transmission and incidence in these three countries can be explained by the rapid accumulation of susceptible children. Despite the organization of mass vaccination activities, measles incidence through 2017 has remained higher than the pre-Ebola period in all three countries.ConclusionThe Ebola outbreak in West Africa significantly affected measles vaccination coverage rates in two of the three worst affected countries, and led to persistent gaps in coverage, along with high measles incidence that was documented until two years after the end of the Ebola outbreak. Liberia and Sierra Leone have demonstrated coverage improvements after the end of the Ebola outbreak.

Purulent Meningitis in Children: A Retrospective Study of 70 Cases in Senegal

Introduction: Despite much progress, purulent childhood meningitis (PCM) remains a public health problem. The objective of this work was to determine the epidemiological, clinical, therapeutic and evolutionary profile of purulent meningitis in children. Methods: Based on retrospective work carried out over a 4-year period (01 January 2014 to 31 December 2017), we studied the epidemiological, clinical, therapeutic and evolutionary aspects of cases of purulent meningitis hospitalized in the pediatric ward of the Children's Hospital of Diamniadio. Included were all children from 29 days to 15 years of age in whom the diagnosis of purulent meningitis was confirmed by the laboratory. Results: The hospital frequency was 1.9%. The mean age of the patients was 41.0 months. Among the affected children, 68.6% were fully vaccinated. The main germ was Neisseria meningitidis W135 (58.8%). Third generation cephalosporins were the antibiotics of choice (97.1%). No resistance was found to them. The cure rate with sequelae was 5.7%. Streptococcus pneumoniae was the germ responsible for 50% of the objective sequelae. The mortality rate was 7.1%. Conclusion: Neisseria meningitidis W135 is the main germ of purulent meningitis in our study. It is not included in the national routine immunization. It is imperative to adapt vaccination to the epidemiological fluctuation of pathogens in our regions.