Tetanus Vaccination Coverage Research Articles

Higher education associated with better national tetanus vaccination coverage: A population-based assessment

Vaccination coverage among United States (U.S.) adults for tetanus continues to be lower than the national goals. Education has demonstrated a positive impact on vaccination coverage. However, recently there have been outbreaks of vaccine preventable conditions in areas with high college completion rates. This study assessed the relationship between education and tetanus vaccination. Data from the 2016 Behavioral Risk Factor Surveillance System (BRFSS), a self-reported annual survey for non-institutionalized adults in the US from the Centers for Disease Control, was analyzed in 2019. The outcome was up-to-date tetanus vaccination if received within the last 10 years. Education was categorized into 1) grade 11 or less, 2) grade 12/GED, 3) college 1–3 years, and 4) college 4 or more years. Bivariate analyses and multivariable logistic regression were conducted on the analytic sample (n = 417,473) using Stata 15, accounting for weighting and the complex survey design. In 2016, 59.9% of U.S. adults had up-to-date tetanus vaccination. Higher education level was associated with increased odds of up-to-date tetanus vaccination. The highest odds were for those with 4 or more years of college education [aOR = 1.31; 95% (CI: 1.26–1.35)]. Female sex, Black (non-Hispanic), unemployed, not being married, not having insurance or a personal health care provider, and above 45 years of age had lower odds of up-to-date tetanus vaccination. Targeted community specific vaccination education programs for those without tertiary education may help enhance the knowledge and thus the overall vaccination status in the U.S.

Determinants of Noncompletion of the Third Dose of Tetanus Toxoid Vaccine in Pregnant Women in Dschang Health District, Cameroon.

Introduction. Tetanus vaccination plays an important role in the fight against neonatal mortality. Our study aimed to determine the noncompletion rate of the 3rd dose of tetanus toxoid vaccine (TTV) and to analyze the associated factors in pregnant women. Methods This was a cross-sectional study conducted in 2 hospitals of Dschang Health District and targeting all women at least in their second gestation coming for antenatal consultation. Upon informed consent by the participant, a prepared questionnaire was administered. The collected data was analyzed using SPSS v22.0 with results presented in means and proportions. Logistic regression was used at two levels to identify independently associated factors for noncompletion of the third dose of TTV with a significance set at 5%. Results A total of 380 pregnant women were recruited in this study of mean age 27 ± 5.2 yrs, 70% being married, more than 80% having at least secondary education, and 31.8% of them being students. It was noted that 172 (45.26%) of these women had not received the third dose of TTV. The analysis of the adjusted effects showed that not going to postnatal consultation (aOR = 6.75; 3.98–11.49, p < 0.0001), not accompanying her baby to vaccination (aOR = 3.784; 1.803–7.942, p < 0.0001), not accompanying her baby to vaccination (aOR = 3.784; 1.803–7.942, p < 0.0001), not accompanying her baby to vaccination (aOR = 3.784; 1.803–7.942, Conclusion Tetanus vaccination coverage is not yet optimal in Dschang Health District and is associated with marital status as well as postgestational behavior of the mothers. There is thus the need to put in place strategies that will provide social support to single mothers as well as encourage women to attend postnatal consultation and to accompany their own children for vaccination. Furthermore, community-based vaccination could capture some of the lost women thus optimizing the overall vaccination coverage.

1646. Education Level is Associated with Tetanus Vaccine Coverage: Results from the 2016 BRFSS

BackgroundVaccination coverage among US adults for tetanus, a potentially fatal disease, continues to be lower than the national goals. Education has been considered to have positive impact on vaccination coverage. However, recently there have been outbreaks of vaccine preventable conditions in areas with high college completion rates. This study aims to assess the relationship between education and vaccination coverage. Specifically, we looked at the association between education level and tetanus vaccination status of the US adults.MethodsData from the 2016 Behavioral Risk Factor Surveillance System, a self-reported annual survey for non-institutionalized adults in the United States from the Centers for Disease Control, were analyzed. The outcome was up-to-date tetanus coverage (within the last 10 years) defined by the response to: have you received tetanus vaccine since 2005? Education was stratified into four categories: (1) grade 11 or less, (2) grade 12/GED, 3) college 1–3 years, and (4) college 4 or more years. Bivariate analyses and multivariable logistic regression were conducted on the analytic sample (n = 417,473) using Stata 15, accounting for weighting and the complex survey design of the BRFSS.ResultsThis study identified that 59.9% of US adults are up-to-date on the tetanus vaccine status (Table 1). Higher education level was found to be associated with increased odds of up to date tetanus vaccination. The highest odds were for those with 4 or more years of college education [aOR = 1.31; 95% CI: 1.26–1.35)] while the lowest odds were for those less than grade 11 education, when compared with those with a high school degree [aOR = 0.93; 95% CI: 0.88–0.98] (Figure 1). Other covariates identified as negatively associated with up-to-date tetanus status were race/ethnicity, female sex, unemployment, not being married, not having insurance or a personal healthcare provider, and being above 45 years of age (Figure 1).ConclusionThis study identified a positive association between up-to-date tetanus status and higher education level. Introducing community-specific vaccination education programs for those without tertiary education, especially for those above age 45 and without insurance, may help increase the overall vaccination status in the United States. Disclosures All authors: No reported disclosures.

Factors Contributing to Low Tetanus Toxoid Vaccination Coverage among Young Adult Women in Khairpur District, Sindh

Background: Tetanus remains endemic in poor and developing countries since last decades as compared to rich and advanced countries. Low Tetanus Toxoid (TT) vaccination coverage has led to Tetanus related high morbidity and mortality amongst women and children in developing countries like Pakistan. Therefore, this study aims to assess the coverage of TT vaccination, knowledge about importance of TT vaccination and barriers to get full coverage among young women. Methodology: A cross-sectional study was conducted in district Khairpur among the female students of one Public Sector University. Total of 384 unmarried female students of more than 17 years of age were enrolled in the study. Information on vaccination status and different associated factors was collected through a questionnaire. We used logistic regression analysis to assess factors associated with vaccination status. Results: The mean age of study participants were 20.9 years with 2.15 standard deviation. Total of 311 (81%) respondents had heard about TT vaccination and among 160 (41.7%) major source of information was health care provider. Most of the respondents 303 (78.9%) were considering Tetanus as a health problem. Furthermore, 141 (36.7%) respondents knew that completion of 5 doses of TT vaccination can protect them from Tetanus disease. About 53 % young women were vaccinated for TT including 11% fully vaccinated and 42% partially vaccinated. In multivariable model, those who were aware of Tetanus diseases were more likely to be vaccinated than those who had not heard about Tetanus disease (odds ratio 2.76: 95% confidence interval; 1.19-6.43). Conclusion: We have found significant relationship of knowledge of Tetanus disease and vaccination coverage in the young adult women of Khairpur district. Study suggests the enhanced focus of government and other stakeholders on women’s health education which can increase the uptake of vaccination among young women.

Pertussis epidemiological pattern and disease burden in Brazil: an analysis of national public health surveillance data

ABSTRACTObjective: We described pertussis epidemiological trends in Brazil between 2010 and 2015. We also assessed tetanus, diphtheria and acellular pertussis (Tdap) vaccine coverage among pregnant women from 2014, the year of the introduction of Tdap maternal immunization recommendation in Brazil, to 2016.Methods: Epidemiological data for incidence, prevalence, hospitalization, mortality, and maternal vaccination coverage were calculated based on the Brazilian public surveillance databases.Results: The epidemiological data analysis results showed that the pertussis average incidence rate (IR) was 2.19/100,000 inhabitants for all ages, with a peak in 2014 (4.03/100,000 inhabitants) and highest incidence in <1-year-old children (IR = 175.20/100,000). 97.6% of pertussis deaths (405/415) were in <1-year-old children. Maternal immunization coverage was 9.2% in 2014, 40.4% in 2015, and 33.8% in 2016.Conclusions: Pertussis incidence and pertussis-related deaths increased in Brazil from 2010 to 2014 and decreased in 2015. In the two years, 2015 and 2016 that followed the NIP recommendation, Tdap vaccination coverage of pregnant women was low and varying from region to region. More efforts and national plans would help increase awareness and maternal immunization coverage.

Determinants of Tetanus Vaccination among Adult Immigrants: Findings from the Portuguese National Health Survey 2014.

Vaccination is an effective strategy to prevent tetanus, and in Portugal this service is provided free of charge. Despite this, immigrants reported lower tetanus vaccination coverage than did Portuguese natives. The objective of this study was to identify sociodemographic, migration-related, and access-to-care factors associated with tetanus vaccination coverage among adult immigrants, using data from the Portuguese National Health Survey 2014. For the sample of 1277 immigrants aged ≥18 years, we estimated self-reported tetanus vaccination within the preceding 10 years and its determinants using complex samples logistic regression. The overall self-reported tetanus vaccination coverage was 79.5% (95% CI: 75.8–82.8). Age (adjusted odd ratio (aOR) per 1 year age increase = 0.97, 95% CI: 0.95–0.99), higher household income per adult (aOR = 0.42, 95% CI: 0.19–0.96), having Portuguese citizenship (aOR = 2.30, 95% CI: 1.25–4.24), having private health insurance (aOR = 1.99, 95% CI: 1.06–3.71), and contact with family/general physician in the last 12 months (aOR = 1.59, 95% CI: 1.01–2.51) were associated with self-reported tetanus vaccination coverage among adult immigrants. We also found significant disparities in coverage between regions of residence. This study identified several determinants associated with self-reported tetanus vaccination coverage among adult immigrants in Portugal. These findings may help policymakers to design specific interventions to increase tetanus vaccination coverage among this population.

Family-centric safe motherhood approach for marginalized young married couples in rural India.

Background:India contributes high broaden of maternal and child death globally. Over the past decade, there has been considerably improvement in maternal and child health indicator in India with intervention of national health mission. However, inequalities in basic health outcomes, lack of access and poor quality of medical care still exists. Marginalized, poor, and rural populations have noticeable low health indicators.Aim:The aim of this study isto describe the design, implementation, and baseline findings of “family centric safe motherhood approach among marginalized young married couples in rural India.Settings and Design:To establish a baseline, we completed 1347 interviews in 100 villages from two rural blocks (Balotra and Siwana) of Rajasthan, India.Methods:The progress of health outcomes is to be measured by set of indicators. Based on results, intervention package was developed.Statistical Analysis Used:The data were entered in SPSS 22 version. Bivariate analysis was performed.Results:Around two-fifth of couples (42.9%) used any temporary contraceptive method. Although the percentage of antenatal care (ANC) in the first trimester (77%) was high, but only 10% of them received three or more ANC check-up. Institutional delivery was reported to be 64.5%. Less than 10% of the women reported that they received quality of ANC (7.1%) and 32.7% was tetanus vaccination coverage in the study area. Aware of any contraceptive method was above 92.7% and 64.3% of respondents have an intention to use any family planning method in the next 12 months.Conclusions:These data provide a baseline of crucial information for evidence-based action on maternal and child health at rural inaccessible villages. Our baseline estimates will facilitate the evaluation of interventions and feasibility of scaling up of intervention.

Progress towards achieving and maintaining maternal and neonatal tetanus elimination in the African region.

Despite the availability of effective tetanus prevention strategies, as of 2016, Maternal and Neonatal Tetanus Elimination (MNTE) has not yet been achieved in 18 countries globally. In this paper, we review the status of MNTE in the World Health Organization African Region (AFR),and provide recommendations for achieving and maintaining MNTE in AFR. As of November 2016, 37 (79%) AFR countries have achieved MNTE, with 10 (21%) countries remaining. DTP3 coverage increased from 52% in 2000 to 76% in 2015. In 2015, coverage with at least 2 doses of tetanus containing vaccine (TT2+) and proportion of newborns protected at birth (PAB) were 69% and 77%, compared with 44% and 62% in 2000, respectively. Since 1999, over 79 million women of reproductive age (WRA) have been vaccinated with TT2+ through supplementary immunization activities (SIAs). Despite the progress, only 54% of births were attended by skilled birth attendants (SBAs), 5 (11%) countries provided the 3 WHO-recommended booster doses to both sexes, and about 5.5 million WRA still need to be reached with SIAs. Coverage disparities still exist between countries that have achieved MNTE and those that have not. In 2015, coverage with DTP3 and PAB were higher in MNTE countries compared with those yet to achieve MNTE: 84% vs. 68% and 86% vs. 69%, respectively. Challenges to achieving MNTE in the remaining AFR countries include weak health systems, competing priorities, insufficient funding, insecurity, and sub-optimal neonatal tetanus (NT) surveillance. To achieve and maintain MNTE in AFR, increasing SBAs and tetanus vaccination coverage, integrating tetanus vaccination with other opportunities (e.g., polio and measles campaigns, mother and child health days), and providing appropriately spaced booster doses are needed. Strengthening NT surveillance and conducting serosurveys would ensure appropriate targeting of MNTE activities and high-quality information for validating the achievement and maintenance of elimination.

Tetanus disease and deaths in men reveal need for vaccination.

With efforts focused on the elimination of maternal and neonatal tetanus, less attention has been given to tetanus incidence and mortality among men. Since 2007 voluntary medical male circumcision has been scaled-up in 14 sub-Saharan African countries as an effective intervention to reduce the risk of human immunodeficiency virus (HIV) acquisition among men. As part of a review of adverse events from these programmes, we identified 13 cases of tetanus from five countries reported to the World Health Organization (WHO) up to March 2016. Eight patients died and only one patient had a known history of tetanus vaccination. Tetanus after voluntary medical male circumcision was rare among more than 11 million procedures conducted. Nevertheless, the cases prompted a review of the evidence on tetanus vaccination coverage and case notifications in sub-Saharan Africa, supplemented by a literature review of non-neonatal tetanus in Africa over the years 2003–2014. The WHO African Region reported the highest number of non-neonatal tetanus cases per million population and lowest historic coverage of tetanus-toxoid-containing vaccine. Coverage of the third dose of diphtheria–tetanus–polio vaccine ranged from 65% to 98% across the 14 countries in 2013. In hospital-based studies, non-neonatal tetanus comprised 0.3–10.7% of admissions, and a median of 71% of patients were men. The identification of tetanus cases following voluntary medical male circumcision highlights a gender gap in tetanus morbidity disproportionately affecting men. Incorporating tetanus vaccination for boys and men into national programmes should be a priority to align with the goal of universal health coverage.

An approach for estimating vaccination coverage for communities using school-level data and population mobility information

Childhood vaccination data are made available at a school level in some U.S. states. These data can be geocoded and may be considered as having a high spatial resolution. However, a school only represents the destination location for the set of students who actually reside and interact within some larger areal region, creating a spatial mismatch. Public school districts are often used to represent these regions, but fail to account for private schools and school of choice programs. We offer a new approach for estimating childhood vaccination coverage rates at a community level by integrating school level data with population commuting information. The resulting mobility-adjusted vaccine coverage estimates resolve the spatial mismatch problem and are more aligned with the geographic scale at which public health policies are implemented. We illustrate the utility of our approach using a case study on diphtheria, tetanus, and pertussis (DTP) vaccination coverage for kindergarten students in California. The modeled community-level DTP coverage estimates yield a statewide coverage of 92.37%, which is highly similar to the 92.44% coverage rate calculated from the original school-level data.

Effet de la réorganisation des services sur les consultations prénatales à l’Hôpital Général de Marcory, Côte d’Ivoire

Improvement of the work environment and staff training are health promotion strategies that can contribute to improving the supply of health care. This study evaluated the effects of reorganization of health services on antenatal care (ANC) activities. A cross-sectional study was conducted over a period of 4 months in the ANC unit of Marcory General Hospital in Abidjan. The study population was health workers in charge of ANC and pregnant women attending the health facility. Self-administered questionnaires and observation sheets were used to collect data that were analysed with Epi Info 3.5.1 software. results: After reorganization, health workers said they were satisfied with the work environment and the care provided in 91% and 96.9% of cases, respectively. These results were confirmed by all pregnant respondents (100%) attending the centre, who said they were satisfied with the quality of care received. This could explain the ANC 4 coverage rate, which increased from 39.4% in 2010 to 56.7% in 2012 and tetanus vaccination coverage which increased from 59.4% to 87.5%, although the waiting time was still too long. This study showed an increase of ANC activity indicators, such as ANC 4 and tetanus vaccination coverage rate, after reorganization of health care services. This strategy could be an opportunity to strengthen ANC services.

Low tetanus, diphtheria and acellular pertussis (Tdap) vaccination coverage among HIV infected individuals in Austria

Current management guidelines of HIV infected adults include recommendation to immunization against common vaccine preventable diseases. This effort is hindered by the scarce knowledge regarding the immunization status of this especially vulnerable patient group. This study analyzed the serostatus for pertussis, diphtheria and tetanus of more than 700 HIV infected individuals residing in Austria. These individuals were representative for the Austrian HIV cohort regarding sex, age, transmission risk and HIV progression markers. Overall, 73.6% were on suppressive HAART, mean CD4 cell count was 603c/μl. Seropositivity was 84% for diphtheria, 51% for tetanus and 1% for pertussis. Migrants had a lower chance of tetanus seropositivity (OR 0.30 (CI 0.21 to 0.43)). Increase in CDC classification were associated with increased diphtheria seropositivity (OR 1.42 (CI 1.02 to 1.98)) and a CD4 nadir<200c/μl was associated with increased pertussis seropositivity (OR 12.2, 95% CI 1.2 to 121). Importantly due to the well preserved immune status of nearly all participants vaccination would be feasible in the majority of the seronegative patients. In patients with a CD4 count>200c/μl, 95% lacked seroprotection to at least one of the antigens included in the triple vaccine Tdap and could be vaccinated. Thus, a proactive approach would largely reduce the number of patients at risk for these vaccine-preventable diseases.

Influenza, tetanus, and pertussis vaccination coverage among adults in Germany

In order to be adequately protected throughout life and to protect specific risk groups from particular diseases, regular booster or specific indicator vaccinations are also recommended during adulthood. Adults should be vaccinated against seasonal influenza (annually, e.g., persons with underlying chronic diseases and persons aged ≥ 60 years), tetanus (every 10 years), and pertussis (as a one-time vaccination with the next due tetanus vaccine and, e.g., when people have close contact to newborn babies). The aim of this study was to provide an overview of the current status of vaccination uptake among adults living in Germany, focusing on these three vaccines. In line with nationwide continuous health monitoring, the Robert Koch Institute conducted the representative study "German Health Update" (GEDA 2012) between 2012 and 2013. The survey is conducted regularly and adults are asked questions relating to their vaccination status through computer-assisted telephone interviews. Overall, 19,294 interviews were held. In 2010/2011 and 2011/2012, seasonal influenza uptake among persons aged ≥ 60 years was 54.3 and 52.6 % and among individuals with underlying chronic diseases 46.2 and 42.9 %. 7.6 and 75.6 % of participants reported up-to-date pertussis and tetanus vaccination, respectively. 22 % of people living with a baby in one household were vaccinated against pertussis. In general, vaccination rates against seasonal influenza, pertussis, and tetanus among adults are still low, but differ depending on the specific vaccination. The required aim of the European Commission to reach influenza vaccination coverage by the 2014/2015 winter season of 75 % of higher age groups has not yet been reached. The low pertussis vaccination coverage among persons in close household contact to infants poses a big challenge to the implementation of the cocooning strategy to protect the very vulnerable newborns. To emphasize the importance of a complete vaccination schedule and to increase vaccination uptake, tailored interventions should be provided for both physicians and adults.

Elimination of maternal and neonatal tetanus in Senegal: evolution of survey indicators of 2003-2009

This study aimed to estimate the evolution of the maternal and neonatal tetanus in Senegal from the tetanus vaccination coverage among pregnant women, the proportion of deliveries attended by trained medical personnel and the number of cases of tetanus declared by respective districts, helping to identify districts at high risk of neonatal tetanus (NNT). Data analysis of the epidemiological surveillance realized from 2003 to 2009 in 65 districts of Senegal. Data were collected from the reports of vaccination usage and from the Statistical Directories of the National Health Information Services of the Ministry of Health & Prevention. A district is at high risk when the incidence of NNT is ≥1 case per 1 000 Live births (LB). There were 153 reported cases of NNT in Senegal between 2003 and 2009. National incidence decreased from 0.08 to 0.03 case per 1 000 LB (p = 0,0008). The vaccination coverage of the pregnant women by at least two doses of tetanus vaccine (VAT2+) increased from 66% in 2003 to 78% in 2009. The percentage of districts that had reached a vaccination coverage ≥80% was 20% in 2003 compared to 60% in 2009 (p = 0.009). The proportion of deliveries attended by qualified medical staff evolved from 53% in 2003 to 67% in 2009 (p = 0,02). By 2009, the incidence of NNT was less than 1 case per 1,000 LBs in all districts. Assessing the elimination of maternal and neonatal tetanus in Senegal shows that progress has been made from 2003 to 2009. This was made possible through the organization of vaccination campaigns for women of childbearing age and the improvements in the conditions of deliveries.

Association of Childhood Pertussis With Receipt of 5 Doses of Pertussis Vaccine by Time Since Last Vaccine Dose, California, 2010

In 2010, California experienced its largest pertussis epidemic in more than 60 years; a substantial burden of disease was noted in the 7- to 10-year-old age group despite high diphtheria, tetanus, and acellular pertussis vaccine (DTaP) coverage, indicating the possibility of waning protection. To evaluate the association between pertussis and receipt of 5 DTaP doses by time since fifth DTaP dose. Case-control evaluation conducted in 15 California counties. Cases (n = 682) were all suspected, probable, and confirmed pertussis cases among children aged 4 to 10 years reported from January through December 14, 2010; controls (n = 2016) were children in the same age group who received care from the clinicians reporting the cases. Three controls were selected per case. Vaccination histories were obtained from medical records and immunization registries. Primary outcomes were (1) odds ratios (ORs) for the association between pertussis and receipt of the 5-dose DTaP series and (2) ORs for the association between pertussis and time since completion (<12, 12-23, 24-35, 36-47, 48-59, or ≥60 months) of the 5-dose DTaP series. Logistic regression was used to calculate ORs, accounting for clustering by county and clinician, and vaccine effectiveness (VE) was estimated as (1 - OR) × 100%. Among cases and controls, 53 (7.8%) and 19 (0.9%) had not received any pertussis-containing vaccines, respectively. Compared with controls, children with pertussis had a lower odds of having received all 5 doses of DTaP (OR, 0.11; 95% CI, 0.06-0.21 [estimated VE, 88.7%; 95% CI, 79.4%-93.8%]). When children were categorized by time since completion of the DTaP series, using an unvaccinated reference group, children with pertussis compared with controls were less likely to have received their fifth dose within the prior 12 months (19 [2.8%] vs 354 [17.6%], respectively; OR, 0.02; 95% CI, 0.01-0.04 [estimated VE, 98.1%; 95% CI, 96.1%-99.1%]). This association was evident with longer time since vaccination, with ORs increasing with time since the fifth dose. At 60 months or longer (n = 231 cases [33.9%] and n = 288 controls [14.3%]), the OR was 0.29 (95% CI, 0.15-0.54 [estimated VE, 71.2%; 95% CI, 45.8%-84.8%]). Accordingly, the estimated VE declined each year after receipt of the fifth dose of DTaP. Among children in 15 California counties, children with pertussis, compared with controls, had lower odds of having received the 5-dose DTaP series; as time since last DTaP dose increased, the odds increased, which is consistent with a progressive decrease in estimated vaccine effectiveness each year after the final dose of pertussis vaccine.

La couverture vaccinale des adultes : enquêtes dans quatre populations d'Isère (France), 2002-2003

In order to assess their vaccination policy, the public health authorities in Isère (France) conducted several surveys to determine the vaccination coverage rate among adults. In France, the current state of knowledge in this area is limited. Four separate surveys were conducted in 2002-2003: (1) a telephone survey of 976 adults, 18% of whom had vaccination certificates; (2) a survey of 44 general practitioners (805 patients); (3) a survey of occupational health centers (82 practitioners and 1,119 employees); and (4) a survey of 1,214 patients vaccinated at the international vaccination center in Grenoble (France). The same data were recorded in all four surveys (last vaccination date, either declared by the patient or proven by a vaccination certificate). Based on certified evidence, vaccination coverage for tetanus, diphtheria, and poliomyelitis ranged from 31.6% to 83.9%, from 24.1% to 44.0%, and from 25.9% to 71.9%, respectively. Compared to general practitioners, vaccination coverage was higher among staff working at the occupational health center and lower in the general population. The four surveys covered only part of the adult population and provided only an estimate of vaccination coverage. The study found that tetanus vaccination coverage was the highest, but was still below expected levels. For the other vaccines, vaccination coverage among adults appears to be inadequate. The findings suggest that all health professionals involved in adult vaccination (occupational health doctors, general practitioners, hospital doctors, etc.) should be invited to participate in working groups on vaccination.

Potential Intussusception Risk Versus Health Benefits From Rotavirus Vaccination in Latin America

With the recent postlicensure identification of an increased risk of intussusception with rotavirus vaccine, the 14 Latin American countries currently using rotavirus vaccine must now weigh the health benefits versus risks to assess whether to continue vaccination. To inform policy considerations, we estimated excess intussusception cases and mortality potentially caused by rotavirus vaccine for each of the 14 countries and compared these estimates to hospitalizations and deaths expected to be averted through vaccination. We used regional rotavirus disease burden and rotavirus vaccine efficacy data, global natural intussusception and regional rotavirus vaccine-related risk estimates, and country-specific diphtheria, tetanus, and pertussus vaccination coverage rates to estimate rotavirus vaccine coverage rates. We performed a probabilistic sensitivity analysis to account for uncertainty in these parameters. For an aggregate hypothetical birth cohort of 9.5 million infants in these 14 countries, rotavirus vaccine would annually prevent 144 746 (90% confidence interval [CI], 128 821-156 707) hospitalizations and 4124 deaths (90% CI, 3740-4239) due to rotavirus in their first 5 years of life but could cause an additional 172 hospitalizations (90% CI, 126-293) and 10 deaths (90% CI, 6-17) due to intussusception, yielding benefit-risk ratios for hospitalization and death of 841:1 (90% CI, 479:1 to 1142:1) and 395:1 (90% CI, 207:1 to 526:1), respectively. In an uncertainty analysis using 10 000 simulations of our probabilistic parameters, in comparing rotavirus disease averted to intussusception events caused, the hospitalization ratio was never below 100:1, and our death ratio fell below 100:1 only once. The health benefits of vaccination far outweigh the short-term risks and support continued rotavirus vaccination in Latin America.

The Maoist insurgency (1996–2006) and child health indicators in Nepal

The association of conflict and child health indicators in Nepal was examined for the period of the Communist Party of Nepal-Maoist (CPN-Maoist) insurgency (1996-2006). National and subregional trends in neonatal protection against tetanus, measles and diphtheria-pertussis-tetanus (DPT) vaccine coverage, infant mortality, under-5 mortality, and proportion of underweight or stunted children were examined. During the period of the insurgency there were overall improvements in vaccination coverage; however, measles vaccine and DPT coverage remained static during several years of conflict. A decline in infant and under-5 mortality rates occurred: however, there were smaller improvements in stunting and underweight children. Improvements in health indicators from the Mid-western Hill subregion of the country, an area that was consistently conflict-affected, were less than those achieved nationally or by the less-affected Eastern Hill subregion. In comparison with Bangladesh and India, improvements in Nepal were the same or better, except for stunting and underweight children. Health interventions that are more easily delivered, such as vaccination, showed improvements, although the changes were less in a region of high conflict. Improvements in child nutrition indicators that necessitate multiple, coordinated interventions and access to at-risk populations over time as well as ongoing food security were not as successful. Continued commitment to development of systems for delivery of child health is important to gain improvements across all childhood health indicators.

Influenza, hepatitis B, and tetanus vaccination coverage among health care personnel in the United States

Health care personnel (HCP) are at risk for exposure to and possible transmission of vaccine-preventable diseases. Maintenance of immunity is an essential prevention practice for HCP. We assessed the recent influenza, hepatitis B, and tetanus vaccination coverage among HCP in the United States. We analyzed data from the 2007 National Immunization Survey-Adult restricted to survey respondents aged 18 to 64years. Influenza, hepatitis B, and tetanus vaccination coverage levels among HCP were assessed. Multivariable logistic regression was conducted to assess factors independently associated with receipt of vaccination among HCP. Among HCP aged 18 to 64 years, 46.7% (95% confidence interval [CI]: 39.6%-53.8%) had received influenza vaccination for the 2006-2007 season, and 70.4% (95% CI: 63.9%-76.1%) received tetanus vaccination in the past 10 years; 61.7% (95% CI: 52.5%-70.2%) had received 3 or more doses of hepatitis B vaccination among HCP aged 18 to 49 years. Multiple logistic regression analysis showed that being married was associated with influenza vaccination coverage, higher education level was associated with hepatitis B vaccination coverage, and younger age was significantly associated with tetanus vaccination among HCP. Among those HCP who did not receive influenza vaccination, the most common reason reported was respondent concerns about vaccine safety and adverse effects. By 2007, influenza and hepatitis B vaccination coverage among HCP remained well below the Healthy People 2010 objectives. Tetanus vaccination level was 70%, and this study provided a baseline data for tetanus vaccination among HCP. Innovative strategies are needed to further increase vaccination coverage among HCP.

Déterminants de couverture vaccinale antitétanique chez l’adulte en France et de connaissance du statut vaccinal

Background Every year, 15 to 20 tetanus cases are reported in France. The latest national figures showed that only 62 % of adults were up-to-date for this vaccination. We tried to determine the factors associated with vaccination coverage and with knowledge of vaccination status. Methods We analyzed data from the “Santé et Protection sociale” survey (2002). We analyzed the association between factors and tetanus vaccination coverage. We then explored the association between these factors and knowledge of vaccination status. Results Two demographic variables were only associated with vaccination coverage (higher coverage in male individuals and in individuals living in some regions of the country). Two socioeconomic variables were only associated with knowledge of vaccination status (higher knowledge in people from high income families and in managers/private professionals and in office workers). Coverage and status awareness both decreased with lower education level, in residents of large urban centers and in individuals without private medical insurance, and these two indicators were both associated to age but in an opposite direction. Conclusion Factors influencing vaccination coverage are rather demographic, whereas socioeconomic factors seem to influence more the knowledge of vaccination status. This distinction should help to target public health actions and adapt information for the least covered and the least informed groups.