Third Dose Of Pentavalent Vaccine Research Articles

Reducing routine vaccination dropout rates: evaluating two interventions in three Kenyan districts, 2014.

BackgroundGlobally, vaccine preventable diseases are responsible for nearly 20 % of deaths annually among children <5 years old. Worldwide, many children dropout from the vaccination program, are vaccinated late, or incompletely vaccinated. We evaluated the impact of text messaging and sticker reminders to reduce dropouts from the vaccination program.MethodsThe evaluation was conducted in three selected districts in Kenya: Machakos, Langata and Njoro. Three health facilities were selected in each district, and randomly allocated to send text messages or provide stickers reminding parents to bring their children for second and third dose of pentavalent vaccine, or to the control group (routine reminder) with next appointment date indicated on the well-child booklet. Children aged <12 months presenting for their first dose of pentavalent vaccine were enrolled. A dropout was defined as not returning for vaccination ≥2 weeks after scheduled date for third dose of pentavalent vaccine. We calculated dropout rate as a percentage of the difference between first and third pentavalent dose.ResultsWe enrolled 1,116 children; 372 in each intervention and 372 controls between February and October 2014. Median age was 45 days old (range: 31–99 days), and 574 (51 %) were male. There were 136 (12 %) dropouts. Thirteen (4 %) children dropped out among those who received text messages, 60 (16 %) among who received sticker reminders, and 63 (17 %) among the controls. Having a caregiver with below secondary education [Odds Ratio (OR) 1.8, 95 % Confidence Interval (CI) 1.1–3.2], and residing >5 km from health facility (OR 1.6, CI 1.0–2.7) were associated with higher odds of dropping out. Those who received text messages were less likely to drop out compared to controls (OR 0.2, CI 0.04–0.8). There was no statistical difference between those who received stickers and controls (OR 0.9, CI 0.5–1.6).ConclusionText message reminders can reduce vaccination dropout rates in Kenya. We recommend the extended implementation of text message reminders in routine vaccination services.

Association between delayed pentavalent vaccination and immunisation drop-out in rural western Kenya: findings from a cross-sectional survey

<h2>Abstract</h2><h3>Background</h3> The identification of determinants of vaccination coverage and delays is important because these predictors identify subsets of the population that can be targeted with public health interventions. This study's aims were to determine vaccination coverage and timeliness estimates and to identify risk factors for not being vaccinated or receiving late vaccinations in rural western Kenya. <h3>Methods</h3> The study was set in 120 villages within the Kenya Medical Research Institute and Centers for Disease Control and Prevention (KEMRI/CDC) surveillance system in rural western Kenya. In March, 2013, we did a cross-sectional survey of women in the study district who had infants aged 12–23 months. We excluded data from women who did not have their child's immunisation booklet and could provide only a verbal report of their child's immunisation history. We calculated risk factors for delayed and non-receipt of immunisation using binomial regression with log link. Infants were categorised as "delayed" if immunisation was received more than 28 days from schedule. Analyses were restricted to first and third dose of pentavalent vaccine (diphtheria, tetanus, and pertussis [DTP], hepatitis B, and <i>Haemophilus influenzae</i> type b), measles vaccine, and full immunisation (BCG, three doses of polio, three doses of pentavalent, and measles vaccines). <h3>Findings</h3> We surveyed 2495 women and included data from 1748 women (70%). We excluded data from 747 women (30%) who did not have their child's immunisation booklet card present. Immunisation coverage for pentavalent 1, pentavalent 3, measles, and full immunisation were 99%, 95%, 83%, and 80%, respectively. The proportions of infants with delayed pentavalent 1, pentavalent 3, and measles immunisations were 10%, 24%, and 29%, respectively. Risk factors for not receiving vaccination and delayed vaccination were, overall, similar when estimate trends and confidence intervals were taken in to account. Specifically, infants who received pentavalent 1 late were more likely than children who had the first pentavalent vaccine within schedule to not receive pentavalent 3 (adjusted RR 5·60 [95%CI 3·75–8·37]), measles vaccine (1·47 [1·11–1·94]), and full immunisation (1·87 [1·51–2·32]). Adjusted analyses for predictors of immunisation booklet present at time of survey versus verbal report found that women living closer to the health facility, women with younger infants, and those with male infants were more likely to have an immunisation booklet present at time of survey. <h3>Interpretation</h3> Immunisation coverage for pentavalent 1, pentavalent 3, and measles vaccines was high, but many children receive their vaccinations more than 28 days after the recommended scheduled date. Since late pentavalent 1 vaccination was associated with pentavalent series drop-out, not being immunised against measles, and not being fully immunised, interventions that target infants with delayed pentavalent 1 vaccination may improve overall immunisation coverage. A potential limitation of this study was that almost a third of mothers were excluded because they could provide only a verbal report of immunisation history instead of their child's immunisation booklet. If there were substantial differences in characteristics between those with an immunisation booklet and those without, and these characteristics were associated with vaccination coverage and delay, the reported estimates may be susceptible to bias. <h3>Funding</h3> The Bill and Melinda Gates Foundation.

Cost-effectiveness of Haemophilus influenzae type b (Hib) vaccine introduction in the universal immunization schedule in Haryana State, India

In India, Haemophilus influenzae type b (Hib) vaccine introduction in the universal immunization programme requires evidence of its potential health impact and cost-effectiveness, as it is a costly vaccine. Since childhood mortality, vaccination coverage and health service utilization vary across states, the cost-effectiveness of introducing Hib vaccine was studied in Haryana state. A mathematical model was used to compare scenarios with and without Hib vaccination to estimate the cost-effectiveness of Hib vaccine in Haryana from 2010 to 2024. Demographic and National Family Health Surveys were used to estimate vaccination coverage and mortality rates among children under 5. Hib pneumonia, Hib meningitis and invasive Hib disease incidence were based on Indian studies. Vaccine and syringe prices of the UNICEF supply division were used. Cost-effectiveness from government and societal perspectives was calculated as the net incremental cost per unit of health benefit gained [disability-adjusted life years (DALYs) averted, life years saved, Hib cases averted, Hib deaths averted]. Sensitivity analysis was done using variation in parameter estimates among different states of India. The incremental cost of Hib vaccine introduction from a government and a societal perspective was estimated to be US$81.4 and US$27.5 million, respectively, from 2010 to 2024. Vaccination of 73.3, 71.6 and 67.4 million children with first, second and third dose of pentavalent vaccine, respectively, would avert 7 067 817 cases, 31 331 deaths and 994 564 DALYs. Incremental cost per DALY averted from a government (US$819) and a societal perspective (US$277) was found to be less than the per capita gross national income of India in 2009. In sensitivity analysis, Hib vaccine introduction remained cost-effective for India. Hib vaccine introduction is a cost-effective strategy in India.