Diphtheria Vaccine Coverage Research Articles

Factors associated with diphtheria vaccination completion among children under five years old in Peru 2010–2019: A cross-sectional population-based study

The World Health Organization (WHO) recommends a minimum of 90% coverage of diphtheria three-dose complete vaccination scheme (DPT) as part of routine immunization programs in children. However, diphtheria coverage in Peru has not reached the minimum recommended during the last decades. Our study aimed to determine the complete three-dose DPT coverage and factors associated with compliance towards complete vaccination in Peru between 2010-2019. We conducted a secondary cross-sectional study using the “Encuesta Demográfica y de Salud Familiar (ENDES)”- Demographic and Family Health Survey, which is a survey that targets mothers between 15 and 49 years of age. DPT vaccination coverage was 72.4% and several factors were associated with the DPT scheme completion. Women in the age groups 18 to 24 (ORa = 2.31, 95%CI: 2.11–2.52), 25 to 34 (ORa = 3.37, 95% CI: 3.08–3.69), and 35 to 49 (ORa = 4.74, 95% CI: 4.29–5.22) were more likely to complete their children's DPT vaccination scheme compared to those between 15 to 17 years of age. Both Spanish (ORa = 1.39, 95% CI: 1.31–1.48) and Quechua (ORa = 1.34, 95% CI: 1.25–1.43) as first spoken language were associated with DPT completion compared to native language speaking mothers. Women who worked (ORa = 1.72, 95% CI: 1.57–1.88), studied (ORa = 1.47, 95% CI: 1.33–1.62), or were housewives (ORa = 1.41, 95% CI: 1.29–1.54) during the previous week were more likely to complete their children's DPT scheme compared to participants that did not work during the previous week. Women with the financial capability to access health care were less likely to complete the DPT scheme (ORa = 0.95, 95% CI: 0.92–0.97). Considering the accessibility to health care centers, women who knew the nearest location (ORa = 1.07, 95% CI: 1.03–1.11), had geographic accessibility (ORa = 1.09, 95% CI: 1.06–1.13) or a current transport (ORa = 1.06, 95% CI: 1.02–1.09) were more likely to complete their children ‘s DPT scheme. Our results highlight low diphtheria vaccine coverage levels in Peru, with values lower than what is recommended by the WHO. Results may serve as a baseline for future studies to improve vaccination programs, reduce barriers and increase DPT coverage in Peru.

An isolated outbreak of diphtheria in South Africa, 2015.

An outbreak of respiratory diphtheria occurred in two health districts in the province of KwaZulu-Natal in South Africa in 2015. A multidisciplinary outbreak response team was involved in the investigation and management of the outbreak. Fifteen cases of diphtheria were identified, with ages ranging from 4 to 41 years. Of the 12 cases that were under the age of 18 years, 9 (75%) were not fully immunized for diphtheria. The case fatality was 27%. Ninety-three household contacts, 981 school or work contacts and 595 healthcare worker contacts were identified and given prophylaxis against Corynebacterium diphtheriae infection. A targeted vaccination campaign for children aged 6-15 years was carried out at schools in the two districts. The outbreak highlighted the need to improve diphtheria vaccination coverage in the province and to investigate the feasibility of offering diphtheria vaccines to healthcare workers.

Primary health care contribution to improve health outcomes in Bogota-Colombia: a longitudinal ecological analysis

BackgroundColombia has a highly segmented and fragmented national health system that contributes to inequitable health outcomes. In 2004 the district government of Bogota initiated a Primary Health Care (PHC) strategy to improve health care access and population health status. This study aims to analyse the contribution of the PHC strategy to the improvement of health outcomes controlling for socioeconomic variables.MethodsA longitudinal ecological analysis using data from secondary sources was carried out. The analysis used data from 2003 and 2007 (one year before and 3 years after the PHC implementation). A Primary Health Care Index (PHCI) of coverage intensity was constructed. According to the PHCI, localities were classified into two groups: high and low coverage. A multivariate analysis using a Poisson regression model for each year separately and a Panel Poisson regression model to assess changes between the groups over the years was developed. Dependent variables were infant mortality rate, under-5 mortality rate, infant mortality rate due to acute diarrheal disease and pneumonia, prevalence of acute malnutrition, vaccination coverage for diphtheria, pertussis, tetanus (DPT) and prevalence of exclusive breastfeeding. The independent variable was the PHCI. Control variables were sewerage coverage, health system insurance coverage and quality of life index.ResultsThe high PHCI localities as compared with the low PHCI localities showed significant risk reductions of under-5 mortality (13.8%) and infant mortality due to pneumonia (37.5%) between 2003 and 2007. The probability of being vaccinated for DPT also showed a significant increase of 4.9%. The risk of infant mortality and of acute malnutrition in children under-5 years was lesser in the high coverage group than in the low one; however relative changes were not statistically significant.ConclusionsDespite the adverse contextual conditions and the limitations imposed by the Colombian health system itself, Bogota’s initiative of a PHC strategy has successfully contributed to the improvement of some health outcomes.

The impact of primary healthcare in reducing inequalities in child health outcomes, Bogotá-Colombia: an ecological analysis.

BackgroundColombia is one of the countries with the widest levels of socioeconomic and health inequalities. Bogotá, its capital, faces serious problems of poverty, social disparities and access to health services. A Primary Health Care (PHC) strategy was implemented in 2004 to improve health care and to address the social determinants of such inequalities. This study aimed to evaluate the contribution of the PHC strategy to reducing inequalities in child health outcomes in Bogotá.MethodsAn ecological analysis with localities as the unit of analysis was carried out. The variable used to capture the socioeconomic status and living standards was the Quality of Life Index (QLI). Concentration curves and concentration indices for four child health outcomes (infant mortality rate (IMR), under-5 mortality rate, prevalence of acute malnutrition in children under-5, and vaccination coverage for diphtheria, pertussis and tetanus) were calculated to measure socioeconomic inequality. Two periods were used to describe possible changes in the magnitude of the inequalities related with the PHC implementation (2003 year before - 2007 year after implementation). The contribution of the PHC intervention was computed by a decomposition analysis carried out on data from 2007.ResultsIn both 2003 and 2007, concentration curves and indexes of IMR, under-5 mortality rate and acute malnutrition showed inequalities to the disadvantage of localities with lower QLI. Diphtheria, pertussis and tetanus (DPT) vaccinations were more prevalent among localities with higher QLI in 2003 but were higher in localities with lower QLI in 2007. The variation of the concentration index between 2003 and 2007 indicated reductions in inequality for all of the indicators in the period after the PHC implementation. In 2007, PHC was associated with a reduction in the effect of the inequality that affected disadvantaged localities in under-5 mortality (24%), IMR (19%) and acute malnutrition (7%). PHC also contributed approximately 20% to inequality in DPT coverage, favoring the poorer localities.ConclusionThe PHC strategy developed in Bogotá appears to be contributing to reductions of the inequality associated with socioeconomic and living conditions in child health outcomes.

디프테리아 백신의 진화와 물리화학적, 분자생물학적, 면역학적 지식의 진보에 따른 새로운 백신의 개발에 관한 고찰연구

This review article provides an overview of the evolution of diphtheria vaccine, its value and its future. Diphtheria is an infectious illness caused by diphtheria toxin produced by pathogenic strains of Corynebacterium diphtheriae. It is characterized by a sore throat with membrane formation due to local tissue necrosis, which can lead to fatal airway obstruction; neural and cardiac damage are other common complications. Diphtheria vaccine was first brought to market in the 1920s, following the discovery that diphtheria toxin can be detoxified using formalin. However, conventional formalin-inactivated toxoid vaccines have some fundamental limitations. Innovative technologies and approaches with the potential to overcome these limitations are discussed in this paper. These include genetic inactivation of diphtheria toxoid, innovative vaccine delivery systems, new adjuvants (both TLRindependent and TLR-dependent adjuvants), and heat- and freeze-stable agents, as well as novel platforms for producing improved conventional vaccine, DNA vaccine, transcutaneous (microneedle-mediated) vaccine, oral vaccine and edible vaccine expressed in transgenic plants. These innovations target improvements in vaccine quality (efficacy, safety, stability and consistency), ease of use and/or thermal stability. Their successful development and use should help to increase global diphtheria vaccine coverage.

Évolution de la couverture vaccinale de l’année scolaire 2003–2004 à 2007–2008 pour les enfants de cinq à six ans à Genève

Objective The authors had for aim to study the evolution of vaccination coverage for diphtheria, tetanus, pertussis, poliomyelitis, measles, mumps, rubella (MMR) and Haemophilus influenzae b (Hib) in 5 to 6-year-old children in Geneva, from school year 2003–2004 to 2006–2007. Design The data was collected from vaccination cards of 17,184 children attending public schools in the Geneva canton. Results The average vaccination coverage over the study period was 93.4% for diphtheria, 93.5% for tetanus, 92.5% for pertussis, and 92.4% for poliomyelitis. For MMR and Hib, the coverage was 80.6, 78.4, 79.1 and 81.2% respectively. Between 2003 and 2007, an increase of coverage was observed for all vaccines. It was especially observed for MMR and Hib vaccines, even though the coverage remained below 90%. Conclusion In the Geneva canton, epidemiological surveillance of vaccination coverage of 5 to 6-year-old children can be achieved through systematic data analysis of children's vaccination cards. All commonly used vaccines reached the recommended coverage rates, except for MMR and Hib, even though their coverage had significantly increased.

Vaccination rates in a multicultural population

Aims: To establish whether there are social or cultural groups of children in Amsterdam with relatively low vaccination coverage for diphtheria, pertussis, tetanus, and poliomyelitis (DPTP), and for measles, mumps,...

Epidemiology of epidemic diphtheria in three regions, Russia, 1994-1996.

A massive diphtheria epidemic which began in the former Soviet Union in 1990 is the first large-scale diphtheria epidemic in developed countries in more than 30 years and has primarily affected adults. In response, health authorities attempted to maximize vaccination for children and conducted an unprecedented campaign to vaccinate adults. We analyzed diphtheria surveillance data (case report forms and diphtheria vaccine coverage data) from three Russian regions from January 1994 to December 1996 and estimated vaccine effectiveness by the screening method. We reviewed records from 2243 (97.2%) of 2307 reported cases. The highest cumulative incidence in the period was among children aged 5 to 9 years (106 cases per 100,000 population); adults aged 40-49 years had the highest adult incidence for disease (88 cases per 100,000) and the highest incidence of any age group of clinically severe disease (29 cases per 100,000) and death (5.1 deaths per 100,000). The incidence among women aged 2049 years (82 per 100,000 women) was higher than among men (47 per 100,000, p<0.01). The annual incidence decreased from 25.2 cases per 100,000 population in 1994 to 9.4 cases per 100,000 in 1996. The decrease occurred as adult coverage increased from an estimated 25-30% in December 1992 to 88% in December 1995. Vaccine effectiveness was high among both children and adults. The Russian diphtheria epidemic primarily affected adults, especially women; this pattern is likely representative of diphtheria epidemics in immunized populations. Raising childhood immunization coverage and mass adult vaccination was effective in controlling the Russian epidemic. An improved understanding of the current epidemiology of diphtheria will be useful to design public health responses to prevent or control modern epidemics.