Universal Immunization Program Research Articles

Awareness About Child Immunization among Women in Rural Area of District Jalaun

Introduction; Universal Immunization Programme (UIP) is one of the largest public health programmes targeting close of 2.67 crore newborns and 2.9 crore pregnant women annually. It is one of the most cost-effective public health interventions and largely responsible for reduction of vaccine preventable under-5 mortality rate. Under UIP, immunization is providing free of cost against 12 vaccine preventable diseases. Mission Indra dhanush (MI) was launched in December 2014 and aims at increasing the full immunization coverage to children to 90 % (1). Mother play a very important role in child immunization, so awareness and correct knowledge about immunization is very essential in women, keeping this thing in mind, the present study was undertaken. Aims and objectives;1. To assess the awareness about child immunization among women in rural area.2. To know the correct knowledge of vaccine given in children among women .Material and methods;A cross sectional study was carried out in a rural area of district Jalaun. Aata block was selected randomly for study area. RHTC Aata was selected and women attending the OPD during month of August to October were included in study. Sample size were calculated and 140 mothers were interviewed by using predesigned and pretested questionnaire after taking verbal consent and data was collected and analyzed using appropriate statistical tool. Results; mostly women had heard about immunization in children (82.1%) and most of the women got information from health workers like ASHA/ANM followed by family and friends. vaccine given to child that shows knowledge about BCG/POLIO/MMR was found good but average about DPT and HEPATITIS. Very few women had knowledge about HIB, JE and ROTA vaccine. Conclusion; need to focus on education and awareness programme on women regarding child immunization in rural areas.

IJCM_212A: Assessment of Effective Vaccine Management in Government Health Facilities of Jammu district

Background: The success of immunization depends highly on the level of cold chain maintenance. For effective implementation and success of the Universal Immunisation Programme, proper maintenance of Cold Chain needs a great focus. In 2010, WHO and UNICEF launched the Effective Vaccine Management (EVM) initiative. EVM is a tool which assesses immunization supply chain logistics management. Objectives: To evaluate the performance of Immunization supply chain in cold chain points of Government Health Facilities (HF) of Jammu district Methodology: A facility based cross-sectional study was conducted in Jammu district of UT of J&K. The assessment was done during November 2021– October 2022 using WHO-UNICEF EVM assessment standalone questionnaire generated on EVM assessor app. Sample size and site selection were done using the WHO EVM site selection tool(v1.7-March 2014). A total of 31 HFs were assessed including Divisional Vaccine Store (SN) Results: None of the health facilities reached the WHO recommended overall score of >80%. The criterion scores showed that Facility infrastructure and equipment (E4) and waste management (E9) for District Vaccine Store (LD) was 83% & 86%. Vaccine management (E8) score for SN level & Government Hospital was 88% & 82%. Rest of the CCPs scored less than 80% for all the criteria(E2-E9). The scores of distribution of vaccines and dry goods (E7) were very low for Primary Health Centres (PHC) and Health & Wellness Centres (H&WC) i.e., 39% and 25%. The scores for all the categories(C1-C6) for various CCPs were below 80%. Management criteria scores for supportive supervision(M3) was 0% for all CCP except LD &PHC Conclusion: The overall performance of cold chain in Jammu district was below the recommended level. Supportive supervision, provision of safe disposal pits, power backup, micro plan, training of Cold Chain Handlers and provision of vaccine transportation facility can help in effective vaccine management

Mapping the Socio-Economic Inequalities among Children Aged 0-5 Years in India: A Benefit Incidence Analysis of Universal Immunization Programme

Mapping the Socio-Economic Inequalities among Children Aged 0-5 Years in India: A Benefit Incidence Analysis of Universal Immunization Programme

Expanded spectrum of varicella disease and the need for vaccination in India.

Varicella vaccine was first licensed in Japan and South Korea in 1989 for use in healthy children and was introduced in US in 1995. So far, 29 countries have adopted varicella vaccine in their universal immunization program (UIP). No Asian country, India included, has adopted the varicella vaccine as part of their UIP. The extra-cutaneous sites for VZV diseases are central nervous system and gastrointestinal tract, the expanded disease spectrum includes vasculopathy, myelitis, inflammatory bowel disease, perforated ulcers, and gastritis. The actual disease burden of varicella is not known as most of the infected individuals may not visit the physician. The amplifiable VZV DNA will not always be detectable in cerebrospinal fluid (CSF) samples in protracted illnesses such as vasculopathies, but demonstrable anti-VZV IgG in CSF has diagnostic value. The World Health Organization (WHO) position paper 2014 recommends two doses of varicella and zoster vaccines in targeted population. In India, varicella vaccine is not included in the UIP due to the cost and the belief that lifelong immunity occurs following primary infection. The expanded spectrum of VZV disease and the mounting body of evidence, however, suggest the need for both varicella and zoster vaccines in routine immunization schedule.

Assessing the Impact of the COVID-19 Pandemic on Maternal and Child Health Services: A Comprehensive Analysis of Government Initiatives in Northern India.

The coronavirus disease (COVID-19) pandemic has significantly impacted healthcare services globally, with particular challenges observed in maternal and child health (MCH) care. This study aimed to assess the impact of the pandemic on MCH services in northern India, focusing on key government programs. Data were collected from four major MCH programs in India: Janani Suraksha Yojana (JSY), Janani Shishu Suraksha Karyakram (JSSK), Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), and the Universal Immunization Program (UIP). The study compared MCH service utilization and outcomes during the pandemic period (March-September 2020) with the same period in 2019. Preliminary findings indicated a significant reduction in the utilization of MCH services during the pandemic, with a decrease observed in institutional deliveries, antenatal care visits, and immunization coverage. For instance, institutional deliveries declined by 30% compared with the previous year, with a similar decrease observed in antenatal care visits. Immunization coverage also decreased by approximately 25%, indicating a substantial decline in preventive care services. Challenges in accessing essential treatments for sick infants have also been reported, with a 40% decrease in the utilization of free treatment services under the JSSK program. The COVID-19 pandemic has substantially impacted MCH services in northern India, highlighting the vulnerability of these essential health programs during public health emergencies. Addressing the challenges identified in this study is crucial to ensuring the continuity and resilience of MCH services in similar settings.

Burden of chickenpox complications in Poland, 2006 to 2021: A comprehensive registry-based study.

BackgroundChickenpox, a vaccine-preventable disease caused by the varicella zoster virus, generally presents with mild symptoms but can cause complications necessitating hospitalisation. In Poland, since 2009, vaccination has been obligatory for children up to 12 years of age who are particularly vulnerable to infection and for children in their vicinity.AimTo examine the burden of chickenpox complications and the trends of hospitalisation arising from these complications over time in the Polish population.MethodsData spanning 2006-21 were sourced from the Polish Infectious Diseases Surveillance System, the Nationwide General Hospital Morbidity Study and the Statistics Poland death registry. Standardised and age-specific incidence rates, hospital discharge rates and number of deaths because of chickenpox were calculated. Moreover, the joinpoint regression model was used to analyse trends of annual hospital discharge rates.ResultsOver the analysed timeframe, 25,804 hospitalisations and 52 deaths attributable to chickenpox complications were documented, and 1.0% of chickenpox cases required hospitalisation because of chickenpox. Age-standardised hospitalisation rates varied between 2.3 and 9.6 per 100,000 population. The analysis revealed no statistically significant trend in overall hospital discharge rates from chickenpox complications. However, a notable increase in hospitalisation rates was observed in children aged 0-4 and among inhabitants of rural areas, with annual percentage changes of 4.9% and 3.4% respectively.ConclusionsOur findings suggest that the implementation of a universal chickenpox immunisation programme, supported by health education, should be considered to reduce the number of hospitalisations and nearly eliminate deaths because of chickenpox.

Early estimates of nirsevimab immunoprophylaxis effectiveness against hospital admission for respiratory syncytial virus lower respiratory tract infections in infants, Spain, October 2023 to January 2024.

The monoclonal antibody nirsevimab was at least 70% effective in preventing hospitalisations in infants with lower respiratory tract infections (LRTI) positive for respiratory syncytial virus (RSV) in Spain (Oct 2023-Jan 2024), where a universal immunisation programme began late September (coverage range: 79-99%). High protection was confirmed by two methodological designs (screening and test-negative) in a multicentre active surveillance in nine hospitals in three regions. No protection against RSV-negative LRTI-hospitalisations was shown. These interim results could guide public-health decision-making.

Hospital-based norovirus surveillance in children

After the introduction of the rotavirus vaccine into the Universal Immunization Program in India in 2016, relatively few studies have assessed the prevalence and epidemiological patterns of acute gastroenteritis (AGE) among hospitalized children ≤5 years of age. We used a uniform protocol to recruit children with AGE as well as standardized testing and typing protocols. Stool specimens from children with AGE younger than 5 years of age admitted to six hospitals in three cities in India were collected from January 2017 through December 2019. Norovirus was detected by real-time reverse transcription-polymerase chain reaction (RT-qPCR) followed by typing positive specimens by conventional RT-PCR and Sanger sequencing. Norovirus was detected in 322 (14.8%) of 2182 specimens with the highest rate in 2018 (17.6%, 146/829), followed by 2019 (14.4%, 122/849)and 2017 (10.7%, 54/504). Rotavirus vaccine status was known for 91.6% of the children of which 70.4% were vaccinated and 29.6% not. Norovirus positivity in rotavirus-vaccinated children was 16.3% and 12% in unvaccinated children. GII.4 Sydney[P16] (39.3%), GII.4 Sydney[P31] (18.7%), GII.2[P16] (10%), GI.3[P13] (6.8%), GII.3[P16] (5.9%), and GII.13[P16] (5%) accounted for 85.8% (188/219) of the typed strains. Our data highlight the importance of norovirus in Indian children hospitalized with AGE.

Socio-demographic variables for child immunisation among Khatik population of Delhi

ABSTRACT Background: In India, the Expanded Programme on Immunization was introduced in 1978 and renamed the Universal Immunization Programme in 1985 with the intention of immunising at least 85% of newborns. To improve infant mortality and health outcomes in India and other low and middle income countries, it is critical to understand the local immunisation barriers. Methodology: A community based cross sectional study was conducted amongst the Khatik population of North East Delhi. All childbearing women were included in the study, and data from 387 mothers was collected. Results: The illiteracy rate amongst women (18.3%) was found to be higher compared to that amongst men (7.1%). A high proportion of the children were immunised (98.7%). The results of the chisquare test revealed that the influence of socio demographic variables was not statistically associated, with the immunisation status of the children (P > 0.05). Conclusion: However, it was also evaluated that both mothers and fathers with high and intermediate school levels of education were more likely to immunise their child compared to those who were illiterate, and with primary and middle levels of education. Increasing mothers’ knowledge could help to reduce the number of children who are not immunised.

Strengthening Immunisation Services in India through Digital Transformation from Co-WIN to U-WIN: A Review

Abstract In India, the immunisation programme has made a few technology-dependent advancements. The electronic vaccine intelligence network is to manage the immunisation supply chain and logistics. eVIN ensures the timely and effective distribution of vaccines, contributing to successful immunisation campaigns. The other platform is Co-WIN, which served as the digital backbone for India’s COVID-19 vaccination programme. It facilitates the registration and scheduling of vaccine appointments, tracking of vaccination coverage, monitoring adverse events, enabling a swift and organised response to the pandemic. The U-WIN (universal immunisation) is a comprehensive digital system aligned with the Ayushman Bharat Digital Mission. It connects various key components, including the Healthcare Professional Registry, Healthcare Facility Registry and Ayushman Bharat Health Account. This integrated approach aims to strengthen the Universal Immunisation Programme by leveraging digital technology. Overall, these digital initiatives represent a significant leap in India’s immunisation efforts. They enhance data management, supply chain logistics and healthcare infrastructure while ensuring that the immunisation programme is efficient, accessible and responsive to the needs of the population. This integration of technology and health-care systems is a crucial step toward achieving universal immunisation coverage in the country.

Balancing Routine and Pandemic: The Synergy of India's Universal Immunization Program and COVID-19 Vaccination Program.

The COVID-19 pandemic posed substantial challenges to healthcare systems globally and severely disrupted essential health services, including routine immunization programs. In India, these disruptions were exacerbated due to the sudden emergence of the pandemic and lockdown measures, leading to mass migrations and a shortage of healthcare workers. Caregivers' concerns about routine immunization sessions further compounded the problem, resulting in a sharp increase in zero-dose children. This review paper examines India's strategies for conducting one of the world's largest COVID-19 vaccination programs while effectively restoring and perpetuating its Universal Immunization Program (UIP). The UIP played a pivotal role in sustaining immunization services during the pandemic, ultimately improving immunization coverage compared to pre-pandemic levels. India's accomplishments in this regard are highlighted through key performance indicators, the reach of immunization services, a reduction in zero-dose children, and antigen-wise coverage. The paper also discusses the successful integration of COVID-19 vaccination within the UIP framework, underscoring the significance of existing infrastructure, technology, and capacity building. India's dedication to concurrently managing routine immunization and COVID-19 vaccination showcases the adaptability and resilience of its healthcare system. India's journey serves as a global example of efficient mass immunization during challenging times, emphasizing the importance of political will, healthcare infrastructure investment, skilled healthcare workforces, and comprehensive vaccination programs. In a world grappling with the dual challenge of COVID-19 and routine immunization, India's experience provides a roadmap for strengthening healthcare systems and promoting public health as the critical agenda in challenging times.

U-WIN to Win at Immunisation

India launched the Co-WIN app in 2021 which gained great success in vaccinating the huge population against COVID-19. Motivated by its success, the Government of India has launched the U-WIN app to reach its goals in the immunisation of the country in regards to the UIP (Universal Immunisation Programme). This article will mainly be shedding light on the rationale behind its development, the functionality of the app, training appropriate personnel for its usage, integration with other health platforms, challenges faced previously by the Co-WIN app which could also be faced by the U-WIN app and finally the way forwards regarding the digitalisation of health care in India.

Robust OCR Pipeline for Automated Digitization of Mother and Child Protection Cards in India

The Universal Immunization Programme in India has a mandate to fully vaccinate all of India’s 27 million children born annually. The vaccination doses are recorded by frontline health workers on standardized paper-based Mother and Child Protection (MCP) cards, which are manually digitized by data entry operators, resulting in poor data quality, delays, and significant time and resources. In our article, we focus on Optical Character Recognition– (OCR) based automated digitization of MCP card images captured through a smartphone application developed by us. By utilizing a standardized template for the MCP cards, which is available a priori , we register the card images and perform OCR on the extracted region of interest (ROIs). Since the cards with curvature or torn edges had poor ROIs, we built a global–local alignment technique that first approximates the ROI using global homography and then refines using a local homography resulting in improved accuracy. Our pipeline gives a character level accuracy of 98.73% on our dataset against 75.02% by Google Cloud Vision and 79.26% by Azure OCR. We also describe our field testing experience, where the digitized MCP card images were used to provide useful features on the smartphone application for health workers to conduct vaccination sessions.

Effect of lockdown on routine immunization services in a tertiary care hospital of Rajasthan, India: quarterly analysis

Background: Lockdown was used as a tool to control COVID-19 but it has resulted in the disruption of routine immunization services both in India and globally. Present study aimed to estimate the effect of COVID-19 lockdown periods during years 2020 and 2021 on routine immunization at tertiary-care hospital in Jaipur, Rajasthan, India. Methods: A retrospective record-based observational study was conducted at paediatric tertiary-care hospital, Jaipur. Data were collected from the immunization records of the centre for the vaccines administered to children (0-16 years) under the universal immunization programme (UIP) from January 2019 to December 2021. Doses administered were assessed as a proxy measure of vaccine coverage. The vaccination trends were compared with base year 2019. unpaired ‘t’ test of significance and percent change were used for statistical analysis. Results: The effect of lockdown was maximum in the second quarter of both years 2020 and 2021 with the declination of the total vaccine doses administered by -49.9% and -36.2% respectively. The first lockdown period in year 2020 recorded maximum negative difference in dose of Td (10 years) (-98.4%) followed by DPT booster-2 (-83.6%). The second lockdown in year 2021 recorded maximum negative difference in dose of Td (16 years) (-62.5%) followed by Td-10 years (-58.1%) and DPT booster-2 (-56.5%). Conclusions: This study concludes that the least vaccine doses were administered in second quarter of both years which coincides with lockdown period. Hence during emergencies like lockdown other alternative arrangement for continuance of routine immunization may be implemented.

Assessment of quality of routine immunization in rural areas of Doiwala Block, Dehradun

ABSTRACT Background: India initiated Expanded Programme on Immunization (EPI) in 1978 and was renamed to Universal Immunization Programme (UIP) in 1985 and subsequently integrated with National Rural Health Mission (NRHM) in 2005. Many studies have shown that health workers involved in immunization are more concerned towards coverage than the quality of immunization services provided. Aims and Objectives: This study aimed to assess the quality of routine immunization services in rural areas of Doiwala Block of Dehradun, Uttarakhand. Material and Methods: It was a cross-sectional study conducted for a duration of one year. Study participants included Auxillary Nurse Midwives (ANMs), Accredited Social Health Activists (ASHAs), Anganwadi Workers (AWWs) and parents/caregivers of children aged 12–23 months residing in that area who had received immunization services on the day of the survey. Institutional ethics committee clearance was obtained before the start of the study. A P value of <0.05 was considered as statistically significant. Results: ASHAs at two centres in low-performing centres had never undergone any training for routine immunization but there was no statistically significant difference found between high and low-performing centres (P > 0.05). The most common vaccine not available was the Bacillus Calmette–Guérin (BCG) vaccine. The majority of clients at both high (92%) and low-performing centres (96%) said that they never waited for at least 30 min post-vaccination at the vaccination site for observation. Conclusion: The study highlights that most of the ANMs at the immunization centre were having good knowledge and were adequately trained for maintaining cold chains at session sites.

What Determines the District-Level Disparities in Immunization Coverage in India: Findings from Five Rounds of the National Family Health Survey.

India's Universal Immunization Programme has been performing at a sub-optimal level over the past decade, with there being a wide disparity in terms of immunization coverage between states. This study investigates the covariates that affect immunization rates and inequality in India at the individual and district levels. We used data from the five rounds of the National Family Health Survey (NFHS), conducted from 1992-1993 to 2019-2021. We used multilevel binary logistic regression analysis to examine the association between demographic, socio-economic and healthcare factors and a child's full immunization status. Further, we used the Fairlie decomposition technique to understand the relative contribution of explanatory variables to a child's full immunization status between districts with different immunization coverage levels. We found that 76% of children received full immunization in 2019-2021. Children from less wealthy families, urban backgrounds, Muslims, and those with illiterate mothers were found to have lower chances of receiving full immunization. There is no evidence that gender and caste disparities have an impact on immunization coverage in India. We found that having a child's health card is the most significant contributor to reducing the disparities that exist regarding children's full immunization between mid- and low-performing districts. Our study suggests that healthcare-related variables are more crucial than demographic and socio-economic variables when determining ways in which to improve immunization coverage in Indian districts.

Exploring the Pattern of Immunization Dropout among Children in India: A District-Level Comparative Analysis.

The dropout rate is one of the determinants of immunization coverage and program performance, program continuity, and follow-up. The dropout rate refers to the proportion of vaccine recipients who did not finish their vaccination schedules, and it is determined by comparing the number of infants who started the schedule to the number who completed it. It is the rate difference between the first and final dosage or the rate difference between the first vaccination and the last vaccine dropout; thus, it denotes that the first recommended dose of vaccine was received, but that the subsequently recommended dose was missed. In India, immunization coverage has shown significant improvements over the last two decades, but full immunization coverage has remained stagnant at 76.5%, of which 19.9% are partially immunized, and 3.6% are children who have been left out. In India, the Universal Immunization Programme (UIP) is challenged with cases related to dropout in immunization. Although immunization coverage in India is improving, the program is challenged by vaccination dropouts. This study provides an analysis of the determinants of vaccination dropout in India using data from two rounds of the National Family Health Survey. The finding shows that the mother's age, education, family wealth, antenatal care visit, and place of delivery were some of the variables that significantly contributed to reducing the dropout rate of immunization among children. The findings of this paper show that the dropout rate has reduced over a certain period of time. The overall improvement in the rates of dropout and increase in full immunization coverage could be attributed to various policy measures taken in the last decade in India, which brought structural changes with a positive impact on full immunization coverage and its components.

Addressing Immunization Inequity-What Have the International Community and India Learned over 35 Years?

Countries around the world established immunization programs over 40 years ago to reach all infants. The maturity of these preventive health programs offers some useful learning on the importance of, and components needed for, population-based services to reach all communities. A public health success, ensuring equity in immunization, requires a multi-faceted approach that includes sustained government and partner commitment and human, financial, and program operational resources. Evidence from India's Universal Immunization Program (UIP) across stabilizing vaccine supply and services, enhancing access, and generating demand for vaccines in the community provides a useful case study. The political leadership in India took advantage of the two decades of learning from polio eradication and focused initiatives, such as the National Health Mission and Intensified Mission Indradhanush, to reach populations with immunization services. With a goal of leaving no one behind, India's UIP and partners are bringing essential rotavirus and pneumococcal vaccines nationwide, upgrading vaccine cold chain and supply systems with technologies, such as the electronic Vaccine Intelligence Network (eVIN), and optimizing funding for local needs through the Program Implementation Plan (PIP) budgetary processes and building health worker capacities through training, awareness, and e-learning.

Japanese Encephalitis outbreak in Assam, Northeastern India, January to August 2022

An outbreak of Japanese encephalitis (JEV) was detected in Assam, Northeast India, on July 1st, 2022. The source of human infection is known to be zoonotic transmission from culicine mosquitoes through bites. A total of 434 cases of JEV were recorded between July 1 and September 23, 2022, in 17 separate districts within Assam, India. The precise demographics of these JEV cases remain unknown. The case fatality rate in Assam during this outbreak was 21.43% (93); however, underreporting may occur. JEV is vaccine-preventable, and a vaccine was introduced under the Universal Immunization Programme (UIP) in endemic states to cover children at risk, but not adults. Such serious outbreaks have occurred in the past, with an outbreak in 2006 causing 6061 cases and 1500 deaths. Reports from the current outbreak suggest the cause of the outbreak may be due to prolonged floods resulting in water stagnation in Assam. An unusual feature of the current outbreak is the relatively high CFR and significant neurological involvement. Some key questions include: what is the demographic distribution of JEV cases in Assam? What is the vaccine coverage in Assam? How protective is the JEV vaccine?

Immunogenicity of measles-rubella vaccine administered under India's Universal Immunization Programme in the context of measles-rubella elimination goal: A longitudinal study.

There is a paucity of data regarding immunogenicity of recently introduced measles-rubella (MR) vaccine in Indian children, in which the first dose is administered below one year of age. This study was undertaken to assess the immunogenicity against rubella and measles 4-6 wk after one and two doses of MR vaccine administered under India's Universal Immunization Programme (UIP). In this longitudinal study, 100 consecutive healthy infants (9-12 months) of either gender attending the immunization clinic of a tertiary care government hospital affiliated to a medical college of Delhi for the first dose of routine MR vaccination were enrolled. MR vaccine (0.5 ml, subcutaneous) was administered to the enrolled participants (1st dose at 9-12 months and 2nd dose at 15-24 months). On each follow up (4-6 wk post-vaccination), 2 ml of venous blood sample was collected to estimate the antibody titres against measles and rubella using quantitative ELISA kits. Seroprotection (>10 IU/ml for measles and >10 WHO U/ml for rubella) and antibody titres were evaluated after each dose. The seroprotection rate against rubella was 97.5 and 100 per cent and against measles was 88.7 per cent and 100 per cent 4-6 wk after the first and second doses, respectively. The mean (standard deviation) titres against rubella and measles increased significantly (P<0.001) after the second dose in comparison to the levels after the first dose by about 100 per cent and 20 per cent, respectively. MR vaccine administered below one year of age under the UIP resulted in seroprotection against rubella and measles in a large majority of children. Furthermore, its second dose resulted in seroprotection of all children. The current MR vaccination strategy of two doses, out of which the first is to be given to infants below one year of age, appears robust and justifiable among Indian children.