Supplementary Immunization Campaigns Research Articles

Optimal Timing Regularly Outperforms Higher Coverage in Preventative Measles Supplementary Immunization Campaigns.

Measles threatens the lives and livelihoods of tens of millions of children and there are countries where routine immunization systems miss enough individuals to create the risk of large outbreaks. To help address this threat, measles supplementary immunization activities are time-limited, coordinated campaigns to immunize en masse a target population. Timing campaigns to be concurrent with building outbreak risk is an important consideration, but current programmatic standards focus on campaigns achieving a high coverage of at least 95%. We show that there is a dramatic trade-off between campaign timeliness and coverage. Optimal timing at coverages as low as 50% for areas with weak routine immunization systems is shown to outperform the current standard, which is delayed by as little as 6 months. Measured coverage alone is revealed as a potentially misleading performance metric.

Business Continuity of Polio Eradication in the Context of COVID-19 Pandemic in Pakistan - A Success Story

Background: Pakistan is fighting with wild polio virus and Covid -19. Immunization gap could halt the achievements of Polio program and bridging the gap of immunity was only possible by supplemental immunization. This descriptive observational study on implementation of Supplementary Mass immunization Campaign with Oral Polio Vaccines during Covid -19 pandemic describes the process of strategic shift from conducting small scale target to full scale Pakistan National Immunization day. National Emergency Operational Cell (NEOC) Data was used for accessing the strategic shift & SIA indicator set by Global Polio Eradication Initiative.Methods: We analyzed the changes in process of SIA implementation and comprehended the strategic shift of campaign modalities, provision of personal protective equipment and measurement of the Covid-19 infection incidence amongst frontline health care workers. We analyzed the vaccine refusals numbers to rule out the fear of increase in refusal during Pandemic.Findings: Three SIA rounds were conducted with gradual increase from small-scale test campaign in six districts with children under five targets of seven hundred ninety thousand five hundred twenty-nine to a Sub National Immunization Days (SNIDs) August 2020 campaign conducted targeting thirty-four million under 5 children in one hundred thirty districts and National Immunization Days (NIDs) September 2020 country wide targeting forty million under 5 children in one-hundred sixty-three districts.Interpretation: National Emergency Action Plan(NEAP) of Pakistan has key program indicators. All three campaigns achieved target indicators. Number of vaccine refusal did not increase during Covid -19. Frontline vaccinators were provided with Sufficient number of Mask & Sanitizers and were trained on Standard operating procedures of WHO guideline for Polio SIA implementation. Infectivity with covid-19 did not increase in frontline workers.Funding Statement: No funding is taken for this research.Declaration of Interests: The authors whose names are listed as authors certify that they have No affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patentlicensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.Ethics Approval Statement: Approval was taken from National emergency operational cell, Polio eradication initiative Pakistan.

Measles and Rubella during COVID-19 Pandemic: Future Challenges in Japan.

The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted essential health services. Simultaneously, it has created opportunities for citizens to raise awareness of personal hygiene, mask wearing, and other preventive measures. This brief report aims to clarify the epidemiological trends of measles and rubella in Japan and to explore future challenges for controlling these diseases during and after the COVID-19 pandemic. Although Japan eliminated measles in 2015, the number of measles patients has gradually increased since then, and reached 744 in 2019. In the 2010s, Japan experienced two large rubella epidemics, and the majority of the patients were reported in Tokyo and other metropolitan areas. While the transmission of measles and rubella seems to be suppressed during the COVID-19 pandemic, closing the gap in routine childhood vaccination will be challenging in any country. Moreover, supplementary immunization campaigns for adults have also been disrupted, and they must be invigorated. While the pandemic has a devastating effect on a global scale, it should be utilized as a good opportunity to regain faith in vaccines, implement an evidence-based vaccination policy, and strengthen international cooperation.

Immunity and field efficacy of type 2-containing polio vaccines after cessation of trivalent oral polio vaccine: A population-based serological study in Pakistan

BackgroundIn Pakistan and other countries using oral polio vaccine (OPV), immunity to type 2 poliovirus is now maintained by a single dose of inactivated polio vaccine (IPV) in routine immunization, supplemented in outbreak settings by monovalent OPV type 2 (mOPV2) and IPV. While well-studied in clinical trials, population protection against poliovirus type 2 achieved in routine and outbreak settings is generally unknown. MethodsWe conducted two phases of a population-based serological survey of 7940 children aged 6–11 months old, between November 2016 and October 2017 from 13 polio high-risk locations in Pakistan. ResultsType 2 seroprevalence was 50% among children born after trivalent OPV (tOPV) withdrawal (April 2016), with heterogeneity across survey areas. Supplementary immunization activities (SIAs) with mOPV2 followed by IPV improved population immunity, varying from 89% in Pishin to 64% in Killa Abdullah, with little observed marginal benefit of subsequent campaigns. In the other high-risk districts surveyed, a single SIA with IPV was conducted and appeared to improve immunity to 57% in Karachi to 84% in Khyber. ConclusionsOur study documents declining population immunity following trivalent OPV withdrawal in Pakistan, and wide heterogeneity in the population impact of supplementary immunization campaigns. Differences between areas, attributable to vaccination campaign coverage, were far more important for type 2 humoral immunity than the number of vaccination campaigns or vaccines used. This emphasizes the importance of immunization campaign coverage for type 2 outbreak response in the final stages of polio eradication. Given the declining type 2 immunity in new birth cohorts it is also recommended that 2 or more doses of IPV should be introduced in the routine immunization program of Pakistan.

The cost saving opportunity of introducing a card review into measles-containing vaccination campaigns

Measles vaccination is a cost-effective way to prevent infection and reduce mortality and morbidity. However, in countries with fragile routine immunization infrastructure, coverage rates are still low and supplementary immunization campaigns (SIAs) are used to reach previously unvaccinated children. During campaigns, vaccine is generally administered to every child, regardless of their vaccination status and as a result, there is the possibility that a child that is already immune to measles (i.e. who has had 2+ vaccinations) would receive an unnecessary dose, resulting in excess cost. Selective vaccination has been proposed as one solution to this; children who were able to provide documentation of previous vaccination would not be vaccinated repeatedly. While this would result in reduced vaccine and supply cost, it would also require additional staff time and increased social mobilization investment, potentially outweighing the benefits. We utilize Monte Carlo simulation to assess under what conditions a selective vaccination policy would indeed result in net savings. We demonstrate that cost savings are possible in contexts with a high joint probability of an individual child having both 2+ previous measles doses and also an available record. We also find that the magnitude of net cost savings is highly dependent on whether a country is using measles-only or measles-rubella vaccine and on the required skill set of the individual who would review the previous vaccination records.

VACCINE HESITANCY: A THREAT TO VACCINE PREVENTABLE DISEASE PROGRAMS

Childhood vaccination program provides one of the most cost-effective public health interventions. Vaccination prevents about 2-3 million deaths a year.1 Disease elimination and eradication programs are one of the most effective way to interrupt disease transmission, which results in reducing morbidity and mortality. After successful eradication of small pox in 19772, the world is close to achieve the goal of polio eradication. Polio eradication program has evolved since its beginning around three decades ago. However, the program has seen several challenges during this time around the globe. Hesitation to vaccinate remains one of the most important factors to determine the course of eradication program. Vaccine hesitancy is “the reluctance or refusal to vaccinate despite the availability of vaccines”.1 Any factor affecting the public trust in vaccine safety, purity or efficacy can result in variable level of vaccine hesitancy.3-5 Vaccine hesitancy, if not addressed timely and effectively, can hamper the progress of the program and pose challenges to completion of the disease eradication and elimination programs. Vaccine hesitancy affects the coverage and has impact on overall immunity levels and it needs to be taken seriously. Among all public health interventions, immunization programs were able to investigate the details of the reasons for not vaccinating children. Probably, to our knowledge, the polio program has underwent the most in-depth exploration on the causes of reluctance to vaccinate than any other public health program. However, vaccine hesitancy is comparatively difficult to capture in routine immunization program. Vaccine hesitancy becomes more obvious during supplementary immunization campaigns as the interventions are for brief time and the time taken by community to react to intervention is short as well. While the goal of eradicating polio is near, the issues of vaccine hesitancy are still adversely affecting the global eradication of polio.

Polio supplementary immunization campaign evaluation: The Maban experience, South Sudan, August 2013

The recent polio outbreak in Somalia, Kenya and Ethiopia demanded a safety net Sub-National Immunization Days (SNIDs) for four bordering States, including Upper Nile. Aiming to reach children aged 0-59 months, a house-to-house strategy was employed from 20-23 of August 2013 to vaccinate all children in Maban County. The post Campaign evaluation is conducted to assess coverage by finger mark (quality by proxy) and help to ensure improvements for subsequent campaigns. The main objective of the evaluation was to assess the quality of the campaign to learn lessons for subsequent plans. A total of 31 clusters were covered from both host and refugee areas for this evaluation. Hence, 310 households have been visited by the evaluators. A total of 802 <5 children were enrolled for this evaluation purpose. According to the finding, 97.5% of the children living in the surveyed households have been vaccinated for this round of polio SNIDs, as reported by families; i.e., coverage by history. On the other hand, 87.7% of the children have been vaccinated based on the finger mark; i.e., coverage by finger marks. One hundred and nine children have been missed out of 802 children living in the surveyed households. Besides, 46 children have been identified as first doses of OPV in this campaign, which is 5.9% of the total surveyed children. In addition, 52.3% of families had been investigated for AFP by the vaccination teams. Besides, more than three-fourth of the families knew the campaign before the vaccination team visited their houses. It is recommended to strengthen basic/refresher training of vaccinators, improving supportive supervision, proper estimation of target population and improving social mobilization activities.

Being unvaccinated and having a contact history increased the risk of measles infection during an outbreak: a finding from measles outbreak investigation in rural district of Ethiopia

BackgroundMeasles is one of the most contagious diseases caused by an acute viral illness called Morbillivirus that usually occurs as an outbreak in low-income countries. As of May 2016 measles suspected outbreak was reported from Sekota Zuria district. We investigated the outbreak to identify its possible sources and risk factors of acquiring the infection in the district.MethodWe conducted a 1:2 unmatched case-control study in May 2016 in Sekota Zuria district, Northern Ethiopia. Cases involved in the study were lab confirmed and epidemiologically linked. Controls were those who had no clinical signs of measles and residing in the same communities where the cases were identified. An interviewer-administered questionnaire was used to collect the data. Data were cleaned and entered to Epi-info7 and analyzed using SPSS-20. A logistic regression analysis was conducted to identify risk factors associated with measles infection at a p-value ≤0.05.Results29 cases were identified during the outbreak investigation. The probable source of an outbreak was an index case who had a travel history to a district with a measles epidemic. Five samples were collected for confirmation of the diagnosis. No measles-related deaths were reported. The median age of cases and controls was 15 years (SD ± 7.8) and 11 years (SD ± 9.8), respectively. More than 55% of the cases were in age ≥ 15 years. In the multivariable analysis, being previously vaccinated for measles reduced the risk of measles infection by 83% (AOR, 95%CI = 0.17, 0.05–0.53) and having a contact history increased the risk of measles infection by 3.44 times (AOR, 95%CI = 3.44, 1.26–9.38).ConclusionWe confirmed a measles outbreak in Sekota Zuria district. The majority of the cases were in age ≥ 15 years. Being un-vaccinated and having a contact history with confirmed or suspected cases were increased the risk of measles infection. To catch up with missed children at the time of the first dose of measles vaccine and reduce their susceptibility, supplementary immunization activities (SIAs) or immunization campaigns shall be strengthened.

Lessons learned from detecting and responding to recurrent measles outbreak in Liberia post Ebola-Epidemic 2016-2017.

IntroductionMeasles is an acute viral disease that remains endemic in much of sub-Sahara Africa, including Liberia. The 2014 Ebola epidemic disrupted an already fragile health system contributing to low uptake of immunization services, population immunity remained low thus facilitating recurrent outbreaks of measles in Liberia. We describe lessons learnt from detecting and responding to recurrent outbreaks of measles two years post the 2014 Ebola epidemic in Liberia.MethodsWe conducted a descriptive study using the findings from Integrated Diseases Surveillance and Response (IDSR) 15 counties, National Public Health Institute of Liberia (NPHIL), National Public Health Reference Laboratory (NPHRL) and District Health Information Software (DIHS2) data conducted from October to December, 2017. We perused the outbreaks line lists and other key documents submitted by the counties to the national level from January 2016 to December 2017.ResultsFrom January 2016 to December 2017, 2,954 suspected cases of measles were reported through IDSR. Four hundred sixty-seven (467) were laboratory confirmed (IgM-positive), 776 epidemiologically linked, 574 clinically confirmed, and 1,137 discarded (IgM-negative). Nine deaths out of 1817 cases were reported, a case fatality rate of 0.5%; 49% were children below the age of 5 years. Twenty-two percent (405/1817) of the confirmed cases were vaccinated while the vaccination status of 55% (994/1817) was unknown.ConclusionRevitalization of IDSR contributed to increased detection and reporting of suspected cases of measles thus facilitating early identification and response to outbreaks. Priority needs to be given to increasing the uptake of routine immunization services, introducing a second dose of measles vaccine in the routine immunization program and conducting a high-quality supplementary measles immunization campaign for age group 1 to 10 years to provide protection for a huge cohort of susceptible.

IMPLEMENTATION OF THE WORLD HEALTH ORGANIZATION WESTERN PACIFIC REGIONAL PLAN OF ACTION FOR MEASLES ELIMINATION

Abstract. The Western Pacific Region (WPR) is comprised of 37 countries such as China, Japan, Mongolia, Republic of Korea, The Socialist Republic of Vietnam, Papua-New Guinea, Australia, including Pacific Island Countries and Territories (21 countries of PICTs, approx. 3 million people) etc., with a population of 1.85 billion people. Among them, China is the largest and most populous (1.3 billion people) country of the Region. Large measles outbreaks were documented to occur in the Region. In 2003, the Regional Committee announced officially about the WPR action plan on measles elimination 2005, which, however, failed. Since 2012, WPR countries joined the WHO 2012–2020 Global Measles and Rubella Strategic Plan performing a routine measles vaccination (national immunization schedule) or within Expanded Programme on Immunization (EPI). Basically, a two-dose immunization strategy is followed in the WPR countries. Since 2002, measles supplementary immunization activities (SIAs) in children were conducted in the following countries: Japan, Laos, Vietnam, Philippines, Mongolia, Cambodia, Papua New Guinea, and China. Starting from 2005, measles management was considerably improved, demonstrating by 2012 decreased measles incidence rate down to 5.9 cases per million population. In last years, a decreased measles immunization coverage in decreed population groups was noted in the WPR countries that resulted in 2013–2015 measles epidemic involving almost all regional countries. In particular, in China measles incidence rate was 19.6 cases per million population, whereas in the Vietnam Papua New Guinea and Philippines it progressively increased reaching 182.8, 345.9 and 548.0 cases per million population, respectively. Early children not vaccinated according to schedule, adolescents and young adults dominated among measles patients. It was found that measles outbreaks were due to missed vaccination and increased level of vulnerability to measles. Children under one, adolescents and young adults who did not receive a two-dose measles vaccination were in risk group. Analyzing WPR measles epidemiology demonstrated that refusal of parents to vaccinate children, poor knowledge of advantages related to vaccination, insufficient immunization coverage in immigrants, travelers, subjects changing place of residence, workers of healthcare and educational facilities require special attention. In 2017–2018 season, the following measles genotypes were found in the WPR: D8 — Australia, New Zealand, Republic of Korea, Singapore, Japan; Н1 — China; В3 — Philippines, Australia and Japan; D9 — Singapore, Australia, Macau (China), Malaysia and Japan, Н2 strains endemic in Vietnam. According to the WHO, measles endemic transmission has been successfully interrupted; Australia, Macau, Mongolia and Republic of Korea are being verified to eliminate measles; Hong Kong (China) and Singapore (based on available information) are ready to verify measles elimination. Thus, in the Western Pacific Region measles elimination is achievable after solving current issues such as increasing and maintaining high-level routine vaccination and conducting measles supplementary immunization campaigns in epidemically important contact clusters.

Delivery of Multiple Child and Maternal Health Interventions during Supplementary Immunization Campaign in Rwanda, 2013: Lessons Learnt

This paper assesses and describes the estimated coverage of the Measles Rubella (MR) campaign in each district; the national estimate of coverage for Human Papilloma Virus (HPV) vaccination campaign and Vitamin A supplementation simultaneously implemented in 2013. We applied descriptive statistics and epidemiological tools to the outcomes of the campaigns to assess the coverage achieved on the different child and maternal health interventions. We also assessed the Adverse Events following Immunization (AEFI) where the evaluation was used at the same time to assess the routine immunization performance coverage for children 12-24 months for all childhood antigens, Tetanus Toxoid coverage among mothers of infants, combined with routine immunization performance evaluation, skilled delivery and bed nets use in Rwanda. Results indicated that among the eligible targets, 97.5% received MR vaccine, 91% received HPV doses, and 83% got Vitamin A. The integrated vaccination of MR with HPV did not result in any serious AEFI. Coverage for antigens and doses given early in life was above 95% with card retention of 80%. BCG to measles dropout by card was 8.5%. Main reasons for non-vaccination indicated need for more specific immunization education. About 96.8% of mothers delivered in health institutions and 95% of the mothers slept under bed nets the night before the survey. Rwanda successfully implemented an integrated coverage evaluation survey of the integrated vaccination campaign and routine immunization with statistically valid estimates. We drew lessons that information on routine immunization can be collected during post campaign survey evaluations. The district estimates should guide the programme performance improvement.

Effectiveness of a nationwide measles vaccination campaign in Libya, 2005: Retrospective study

Background: Measles is a highly contagious virus. An effective vaccine has been widely administered for over three decades, but the measles burden is still high, causing 134,200 deaths globally in 2014. In Libya, a national mass measles vaccination campaign took place in 2005 targeting all residents of Libya age 9 months to 20 years between February 2005 5, and March 1, 2005. To date, no evaluation of its effectiveness has been conducted. Materials and Methods: Measles surveillance data were obtained for a 6 years' period (2002–2007) spanning the 3 years before and the 3 years following the mass vaccination campaign. The incidence of measles cases was calculated pre- and postvaccination campaigns and relative change in incidence was determined. Results: During the campaign 2,431,167 people age 9 months–20 years were vaccinated, resulting in a coverage rate of 98.4% in that age range. Comparing incidence of measles cases pre-and postvaccination campaign demonstrates an effectiveness of 96%, P = 0.021. Seasonality of measles cases was identified with a peak in April and May. Effectiveness varied by the age group, ranging from 82% in people lower than 5 years of age. Conclusion: A significant reduction was demonstrated following a national immunization campaign. Supplementary immunization campaigns should be initiated to keep the Libyan measles rate low; allowing the country to move into an elimination period.

Polio immunity and the impact of mass immunization campaigns in the Democratic Republic of the Congo.

BackgroundIn order to prevent outbreaks from wild and vaccine-derived poliovirus, maintenance of population immunity in non-endemic countries is critical.MethodsWe estimated population seroprevalence using dried blood spots collected from 4893 children 6–59 months olds in the 2013–2014 Demographic and Health Survey in the Democratic Republic of the Congo (DRC).ResultsPopulation immunity was 81%, 90%, and 70% for poliovirus types 1, 2, and 3, respectively. Among 6–59-month-old children, 78% reported at least one dose of polio in routine immunization, while only 15% had three doses documented on vaccination cards. All children in the study had been eligible for at least two trivalent oral polio vaccine campaigns at the time of enrollment; additional immunization campaigns seroconverted 5.0%, 14%, and 5.5% of non-immune children per-campaign for types 1, 2, and 3, respectively, averaged over relevant campaigns for each serotype.ConclusionsOverall polio immunity was high at the time of the study, though pockets of low immunity cannot be ruled out. The DRC still relies on supplementary immunization campaigns, and this report stresses the importance of the quality and coverage of those campaigns over their quantity, as well as the importance of routine immunization.

Outbreak of measles in Sokoto State North-Western Nigeria, three months after a supplementary immunization campaign

Outbreak of measles in Sokoto State North-Western Nigeria, three months after a supplementary immunization campaign

Modeling the Impact of Alternative Immunization Strategies: Using Matrices as Memory Lanes.

Existing modeling approaches are divided between a focus on the constitutive (micro) elements of systems or on higher (macro) organization levels. Micro-level models enable consideration of individual histories and interactions, but can be unstable and subject to cumulative errors. Macro-level models focus on average population properties, but may hide relevant heterogeneity at the micro-scale. We present a framework that integrates both approaches through the use of temporally structured matrices that can take large numbers of variables into account. Matrices are composed of several bidimensional (time×age) grids, each representing a state (e.g. physiological, immunological, socio-demographic). Time and age are primary indices linking grids. These matrices preserve the entire history of all population strata and enable the use of historical events, parameters and states dynamically in the modeling process. This framework is applicable across fields, but particularly suitable to simulate the impact of alternative immunization policies. We demonstrate the framework by examining alternative strategies to accelerate measles elimination in 15 developing countries. The model recaptured long-endorsed policies in measles control, showing that where a single routine measles-containing vaccine is employed with low coverage, any improvement in coverage is more effective than a second dose. It also identified an opportunity to save thousands of lives in India at attractively low costs through the implementation of supplementary immunization campaigns. The flexibility of the approach presented enables estimating the effectiveness of different immunization policies in highly complex contexts involving multiple and historical influences from different hierarchical levels.

Legacy of Ebola outbreak: Potential risk of measles outbreak in Guinea, Sierra Leone and Liberia.

Sir, It has been more than a year since the notification of first case of Ebola virus disease in March 2014 in West-Africa, and even now the public health authorities have not been successful to interrupt completely the transmission of the disease.[1] The recent estimates released by the World Health Organization revealed that almost 24907 cases and 10326 associated deaths have been reported worldwide in the affected nations.[2] Although, critical analysis of the affected nations has identified multiple reasons for the rapid progression of the disease, having a weak public health care delivery system with limited human resources/infrastructure support, remains the leading cause, especially in the most severely affected nations, Guinea, Sierra Leone, and Liberia.[3,4] Owing to the unprecedented magnitude of the disease and lack of preparedness, most of the public health authorities and the team of health professionals in the affected nation have diverted their attention to halt the outbreak of Ebola.[5] The estimates pertaining to the pre-Ebola period indicates that only 62-73% of the infants had received measles vaccine in the three of the most affected West-African nations.[6] However, because of this Ebola outbreak, routine immunization activities have taken a toll and a reduction in vaccination coverage has been observed.[5,6] This has been attributed to both health systems (viz. nonfunctional health centers either because of diversion of resources for management of Ebola or because of death of the health workers) and patient-related factors (sense of fear and reluctance to approach health establishments).[5,6,7] In fact, it has been projected that due to the disruption in the routine immunization services for 12-18 months, around 25-75% reduction in the vaccination rates has been observed in West-African nations.[6] Such a massive gap in vaccine coverage can precipitate a major measles outbreak, which itself could account for more than 0.1 million additional measles cases, and even 2000-16000 additional deaths.[6] Furthermore, the risk of a rise in the number of cases of other vaccine-preventable diseases can also be not ruled out.[5,7] Although, it is a fact that no cure is available for either Ebola or measles, nevertheless, a potent and effective vaccine is available for measles which can prevent a person from acquiring the disease.[5] This is a crucial aspect as measles is far more contagious (one case of measles can transmit infection to 12-18 individuals) than Ebola (one case of Ebola is expected to infect 1-2 people).[6] Not only that, in contrast to Ebola, someone with measles is even infectious during the asymptomatic phase and thus it is difficult to interrupt the transmission of the disease.[6] All the stakeholders and international agencies do not want measles to be the second infectious disease, which further affects these nations.[5] Thus, it is very essential to intensify the immunization activities by the prompt initiation of supplementary immunization activities through mass vaccination campaigns.[5,6] However, it is quite difficult to organize the same on a nationwide scale owing to the logistics constraint (viz. equipments for maintenance of cold chain; personal protective equipments to the vaccinators); health workers’ concern (viz. to deal with the myths and misconceptions associated with measles disease, to convince people to come to immunization sessions in health centers where most of them are avoiding hospitals); and psychological issues (viz. to instill a sense of safety among parents and make them understand that it has nothing to do with Ebola).[5,6,7] Although, challenges do exist, still it is not impossible to overcome them, as stakeholders have been successful in organizing supplementary immunization campaigns in all three most severely affected nations.[5] Outbreak response immunization activities have been performed in the measles-affected regions of Liberia and Guinea.[5] In addition, steps have been taken to ensure strengthening of the health infrastructure and implementation of effective infection prevention precautions in Sierra Leone.[8] In fact, the World Health Organization has released new sets of recommendations to perform immunization activities in the African regions, keeping Ebola outbreak in mind and range of precautions, which the health workers should take during the immunization sessions.[9] These immunization activities will not only reduce the risk of a measles outbreak, but even prevent the risk of precipitation of outbreak of other vaccine-preventable diseases.[5,6] To conclude, as Guinea, Sierra Leone, and Liberia, have not yet recovered from the Ebola, it is the responsibility of the program managers, health professionals, and other stakeholders to scale up the immunization activities and strengthen the health care delivery system so that the potential risk of measles outbreak can be prevented.

An acute flaccid paralysis surveillance-based serosurvey of poliovirus antibodies in Western Uttar Pradesh, India.

Despite intensified use of monovalent oral poliovirus type 1 vaccine and improved coverage of immunization campaigns, wild poliovirus type 1 persisted in Indian states of Uttar Pradesh and Bihar during 2006 to 2009. A serosurvey was conducted among cases of acute flaccid paralysis in the 25 high-polio-incidence districts of western Uttar Pradesh. Children were recruited by age group (6-11 months, 12-24 months, and 25-69 months) from among cases reported through the acute flaccid paralysis surveillance system between November 2008 and August 2009. Seroprevalence for type 1 wild poliovirus was >96.4% for each age group. The seroprevalence of wild poliovirus types 2 and 3 increased with age, from 36.7% to 73.4% for type 2 and from 39.0% to 74.1% for type 3. In addition to the number of type-specific vaccine doses, father's level of education, being from a Muslim family, height for age, and female sex were the socioeconomic risk factors associated with seronegativity to poliovirus. The seroprevalence and risk factors identified in this study were consistent with the epidemiology of polio, and the findings were instrumental in optimizing vaccination strategy in western Uttar Pradesh with respect to the choice of OPV types, the frequency of supplementary immunization campaigns, and the urgency to improve routine immunization services.

Seroepidemiology of diphtheria and tetanus among children and young adults in Tajikistan: Nationwide population-based survey, 2010

BackgroundTajikistan had a major diphtheria outbreak (∼10,000 cases) in the 1990s, which was controlled after nationwide immunization campaigns with diphtheria-tetanus toxoid in 1995 and 1996. Since 2000, only 52 diphtheria cases have been reported. However, in coverage surveys conducted in 2000 and 2005, diphtheria-tetanus-pertussis vaccine coverage was lower than administratively reported estimates raising concerns about potential immunity gaps. To further assess population immunity to diphtheria in Tajikistan, diphtheria antibody testing was included in a large-scale nationwide serosurvey for vaccine-preventable diseases conducted in connection with a poliomyelitis outbreak in 2010. In addition, the serosurvey provided an opportunity to assess population immunity to tetanus. MethodsResidents of all regions of Tajikistan aged 1–24 years were included in the serosurvey implemented during September–October 2010. Participants were selected through stratified cluster sampling. Specimens were tested for diphtheria antibodies using a Vero cell neutralization assay and for tetanus antibodies using an anti-tetanus IgG ELISA. Antibody concentrations ≥0.1IU/mL were considered seropositive. ResultsOverall, 51.4% (95% CI, 47.1%–55.6%) of participants were seropositive for diphtheria and 78.9% (95% CI, 74.7%–82.5%) were seropositive for tetanus. The lowest percentages of seropositivity for both diseases were observed among persons aged 10–19 years: diphtheria seropositivity was 37.1% (95% CI, 31.0%–43.7%) among 10–14 year-olds, and 35.3% (95% CI, 29.9%–41.1%) among 15–19 year-olds; tetanus seropositivity in respective age groups was 65.3% (95% CI, 58.4%–71.6%) and 70.1% (95% CI, 64.5%–75.2%). ConclusionsPopulation immunity for diphtheria in Tajikistan is low, particularly among 10–19 year-olds. Population immunity to tetanus is generally higher than for diphtheria, but is suboptimal among 10–19 year-olds. These findings highlight the need to improve routine immunization service delivery, and support a one-time supplementary immunization campaign with diphtheria-tetanus toxoid among birth cohorts aged 1–19 years in 2010 (3–21 years in 2012) to close immunity gaps and prevent diphtheria outbreaks.

Attitudes and Practices of Auxiliary Nurse Midwives and Accredited Social Health Activists in Uttar Pradesh and Bihar Regarding Polio Immunization in India

Although India was removed from the list of polio endemic countries in January 2012, maintaining the focus on polio vaccination is critically important to prevent reintroduction of the virus. In 2009-2010, we conducted a study to assess the attitudes and practices of frontline health workers in India regarding polio immunization in Uttar Pradesh and Bihar. More than 95% of auxiliary nurse midwives (ANMs) and accredited social health activists (ASHAs) agreed that polio supplementary immunization campaigns helped in increasing acceptance of all vaccines. The majority of ANMs (60-70%) and ASHAs (56-71%) believed that polio immunization activities benefitted or greatly benefitted other activities they were carrying out. Less than 5% of ANMs and ASHAs felt they were very likely to face resistance when promoting or administering polio vaccine. This study provides information that may be useful for programs in other countries for polio eradication and in India for measles elimination.

The role of nurses and midwives in polio eradication and measles control activities: a survey in Sudan and Zambia

BackgroundNurses and midwives are the key providers of nursing and midwifery services; in many countries, they form the major category of frontline workers who provide both preventive and curative services in the community. When the skills and experience of nursing and midwifery personnel are maximized, they can contribute significantly to positive health outcomes. We conducted a survey among nurses and midwives working at district level in Sudan and Zambia to determine their roles and functions in polio eradication and measles elimination programmes.MethodsNurses and midwives practising in four selected districts in Sudan and in Zambia completed a self-administered questionnaire on their roles and responsibilities, their routine activities and their functions during supplementary immunization campaigns for polio and measles.ResultsNurses and midwives were found to play significant roles in implementing immunization programme activities. The level of responsibilities of nurses and midwives in their routine work related more to existing opportunities than to their job descriptions.In Zambia, where nurses reported constraints in performing their tasks, the reasons cited were an increase in the burden of disease and the shortage of health personnel. Factors identified as key to improving work performance included written job descriptions, opportunities for staff and career development and opportunities to earn extra income through activities associated with their jobs.Other non-monetary incentives mentioned included reliable transport, resources and logistics to support routine work in the district. However, in both countries, during supplementary immunization activities or mass campaigns for polio eradication and measles control, nurses and midwives took on more management responsibilities.ConclusionThis study shows that nurses and midwives play an important role in implementing immunization activities at the district level and that their roles can be maximized by creating opportunities that lead to their having more responsibilities in their work and in particular, their involvement in early phases of planning of priority health activities. This should be accompanied by written job descriptions, tasks and clear lines of authority as well as good supportive supervision. The lessons from supplementary immunization activities, where the roles of nurses and midwives are maximized, can be easily adopted to benefit the rest of the health services provided at district level.