Vaccination Delay Research Articles

Ethical Issues With Vaccination in Obstetrics and Gynecology: ACOG Committee Opinion, Number 829.

The goals of vaccination are to preserve the health of individual patients as well as the health of the general public. Although interventions to promote individual and public health are usually aligned, ethical challenges may arise that require a balancing or compromise between these two objectives. Major challenges to increasing vaccine uptake and acceptance include widespread misinformation and disinformation on social media regarding safety; limited knowledge and awareness about recommended vaccinations; lack of trust in the medical system, especially in communities of color because of historic and ongoing injustices and systemic racism; prioritization of personal freedoms over collective health; and vaccination delay and refusal through nonmedical exemptions from state-mandated vaccination requirements. Obstetrician-gynecologists are in a unique position to help address these barriers by educating and counseling patients throughout their lifespan, administering recommended vaccinations, and serving as role models in public health initiatives. This document includes updated guidance on the management of ethical issues related to routine vaccination, including vaccination hesitation and refusal by patients, nonmedical exemptions, vaccination during pregnancy and lactation, and physician vaccination. Clinical guidance on vaccination and vaccination during public health emergencies is provided in separate publications and resources from the American College of Obstetricians and Gynecologists.

Modelling the transmission and vaccination strategy for porcine reproductive and respiratory syndrome virus.

Many aspects of the porcine reproductive and respiratory syndrome virus (PRRSV) between-farm transmission dynamics have been investigated, but uncertainty remains about the significance of farm type and different transmission routes on PRRSV spread. We developed a stochastic epidemiological model calibrated on weekly PRRSV outbreaks accounting for the population dynamics in different pig production phases, breeding herds, gilt development units, nurseries and finisher farms, of three hog producer companies. Our model accounted for indirect contacts by the close distance between farms (local transmission), between-farm animal movements (pig flow) and reinfection of sow farms (re-break). The fitted model was used to examine the effectiveness of vaccination strategies and complementary interventions such as enhanced PRRSV detection and vaccination delays and forecast the spatial distribution of PRRSV outbreak. The results of our analysis indicated that for sow farms, 59% of the simulated infections were related to local transmission (e.g. airborne, feed deliveries, shared equipment) whereas 36% and 5% were related to animal movements and re-break, respectively. For nursery farms, 80% of infections were related to animal movements and 20% to local transmission; while at finisher farms, it was split between local transmission and animal movements. Assuming that the current vaccines are 1% effective in mitigating between-farm PRRSV transmission, weaned pigs vaccination would reduce the incidence of PRRSV outbreaks by 3%, indeed under any scenario vaccination alone was insufficient for completely controlling PRRSV spread. Our results also showed that intensifying PRRSV detection and/or vaccination pigs at placement increased the effectiveness of all simulated vaccination strategies. Our model reproduced the incidence and PRRSV spatial distribution; therefore, this model could also be used to map current and future farms at-risk. Finally, this model could be a useful tool for veterinarians, allowing them to identify the effect of transmission routes and different vaccination interventions to control PRRSV spread.

Vaccinating in the Emergency Department, a Model to Overcome Influenza Vaccine Hesitancy.

Introduction:Vaccine hesitancy and delays in vaccine administration time have limited the success of prior influenza vaccination initiatives in the pediatric emergency department (ED). In 2018–2019, season 1, this ED implemented mandatory vaccine screening and offered the vaccine to all eligible patients; however, only 9% of the eligible population received the vaccine. In 2019–2020, season 2, the team sought to improve influenza vaccination rates from 9% to 15% and administer over 2,000 vaccines to eligible ED patients.Methods:Key drivers included: identifying vaccine hesitancy, providing counseling, reducing administration delays, and developing reminders for vaccine administration. We tested interventions using plan-do-study-act cycles. We included discharged ED patients, age 6 months–18 years old, emergency severity index score 2–5, and no prior vaccine this season. Process measures included percent of patients screened, eligible, accepting the vaccine, and leaving before vaccination. Outcome measures were the percent of eligible patients vaccinated and the total number of vaccines administered. Vaccination time was the balancing measure.Results:We included 57,804 children in this study. Comparing season 1 to 2, screening rates (84%) and eligibility rates (58%) were similar. Vaccine acceptance rates improved from 13% to 22%, the proportion of patients leaving before vaccination decreased from 32% to 17%, and vaccination rates improved from 9% to 20%. Total vaccines administered increased from 1,309 to 3,180, and vaccination time was 5 minutes faster in season 2.Conclusions:This ED influenza vaccination process provides a model to overcome vaccine hesitancy and can be adapted and replicated for any vaccine-preventable illness.

Factors Associating Vaccination Delay among Jordanian Children under Two Years of Age

PurposeThis study examines the association between selected socio-demographic factors (gender, birth order, parents' educational levels, and parents' employment status) and reasons for vaccination delay among Jordanian children under two years of age. Design & methodsA cross-sectional, prospective study was conducted in the three comprehensive public health centres in Amman Governorate in Jordan from January–June, 2019. The electronic vaccination record was designed to collect socio- demographic information and reasons for vaccination delay in children. This data was collected from the medical records of those children. ResultsThe findings revealed that 150 (8.3%) children under two years of age were registered as vaccination-delayed cases. The factors associated with vaccination delay were age (Chi-square test [χ2] [6150] = 15.02, p-value [p] < 0.01), birth order (χ2 [6150] = 15.02, p < 0.01), mother's educational level (χ2 [2150] = 9.27, p < 0.05), and father's and mother's employment (χ2 [2150] = 7.89, p < 0.05; χ2 [2150] = 10.54, p < 0.01, respectively). ConclusionTimeliness of vaccination should be promoted to prevent illness outbreaks and provide specific protection for children, taking into consideration the significance of age and birth order. Practice implicationsInterventions and strategies need to implementation to reduce vaccination delay and improve timeliness.

The preferred method for reminding a child's vaccination schedule among Iranian parents.

The most important reason for vaccination delay is the unawareness of the parents of vaccination schedule. The use of reminders can result in better vaccination coverage. This study aimed to determine the preferred method of receiving vaccination reminders from the parents' perspective. Cross-sectional study. We studied the parents of under 7-year-old children who visited one of the six urban health centres in Mashhad for vaccination of their children in 2017. Three hundred parents were participated based on the convenience sampling method. Data were collected using a questionnaire consisting of five sections. Five Medical Informatics specialists confirmed the validity of the questionnaire. The data were analysed by descriptive-inferential statistics and the significance level was set at p<0.05. Around 94% of the participants wanted to be reminded about their children's vaccination schedule. Most of them (74.3%) preferred to receive reminders by short text messaging (SMS) and 42% preferred to be reminded 1 day before the vaccination date (n=42%). The tendency to receive reminders and the preferred method had no significant correlation with participants' age, education degree and residential area. The preferred reminder method from the parents' perspective was SMS. Despite the growth of information technology as well as people's access to the Internet, it seems that use of other methods such as SMS to remind and specifically educate parents in this respect is more common.

Suboptimal vaccination coverage of recommended vaccines among French children with recurrent autoinflammatory fever syndromes: a study from the Juvenile Inflammatory Rheumatism cohort.

To determine vaccination coverage among a French cohort of children with recurrent autoinflammatory fever syndromes (RFS). All RFS children aged 2 to 19years from the Juvenile Inflammatory Rheumatism cohort and followed at the French Reference Center for Autoinflammatory Diseases, Versailles Hospital, were included in our observational study. Immunisation status at ages 2, 7 and 15years and at the last outpatient visit was evaluated according to the standard French vaccine schedule and recommended supplementary vaccines for patients with immunosuppressive therapy. Of 200 patients, 90 (45%) had periodic fever, aphthous stomatitis, pharyngitis and adenitis syndrome; 52 (26%) had familial Mediterranean fever and 50 (25%) had undefined recurrent fever. Complete immunisation as per the standard schedule was obtained by 32% of patients at 2 years, 28% at 7 years, 6% at 15years and 44% at the last outpatient visit. Similar or higher coverage was obtained by the last outpatient visit for most vaccines, compared to immunisation coverage at 2 years: pneumococcus (91% vs 88%), diphtheria tetanus poliomyelitis (82% vs 86%), hepatitis B (79% vs 69%) and measles, mumps, rubella (91% vs 50%). No patients with immunosuppressive therapy (n = 14) were up to date for all supplementary immunisations recommended for them. Vaccination coverage for RFS children is suboptimal, especially for infants who present with recurrent febrile episodes. The initial vaccination delay is partially corrected through specialist follow-up in later years. Coverage according to the supplementary vaccine recommendations for immunosuppressed patients is poor. Key Points • Vaccination coverage for RFS children is suboptimal, especially at 2 years of age which is likely due to the prevalence of early recurrent febrile symptoms. • The initial vaccination delay is partially recovered during later follow-up at an expert rheumatology center. • Specific recommendations are particularly difficult to apply to patients on immunosuppressive therapy.

Prevalence and correlates of vaccine attitudes and behaviors in a cohort of low-income mothers.

The US is facing a rise in vaccine hesitancy, delay, and refusal, though little is known about these outcomes in socio-economically disadvantaged populations. This study examines the prevalence and correlates of vaccine attitudes and behaviors in a diverse cohort of low-income mothers receiving home visiting services. Survey data were collected from 813 recipients of evidence-based home visiting services in Wisconsin from 2013 to 2018. Analyses were performed to describe outcome measures of vaccine attitudes and self-reported completion, and multivariate regressions were used to test associations between vaccine-related outcomes and hypothesized correlates. Most women (94%) reported their children were up to date on vaccines; 14.3% reported having ever delayed vaccination. A small minority disagreed that vaccines are important (5.0%), effective (5.4%), and safe (6.2%), though a larger proportion responded ambivalently (10.9%–21.9%). Participants with greater trust in health care providers reported more positive overall vaccine attitudes (B = 0.24; 95% CI = 0.17, 0.31), a lower likelihood of vaccine delay (OR = 0.57; 95% CI = 0.46, 0.73), and a greater likelihood of being up to date on vaccines (OR = 1.79, 95% CI = 1.30, 2.44). Women with greater trust in a home visitor also rated vaccines more positively (B = 0.09; 95% CI = 0.02, 0.15), and women who reported better mental health were more likely to report their children were up to date (OR = 1.05; 95% CI = 1.02, 1.09). Compared to non-Hispanic whites, American Indians and non-Hispanic blacks had poorer vaccine-related outcomes. More research on vaccine attitudes and behaviors among higher-risk populations is needed to develop tailored strategies aimed at addressing vaccine hesitancy and underimmunization.

Doğuştan Metabolizma Bozukluğu Olan Çocukların Aşılanma Durumlarının Değerlendirilmesi

Objective: Infections generate a metabolic stress in children with inborn errors of metabolism (IEM) and worsen the metabolic abnormalities. Immunization practices prevent children with IEM from vaccine preventable infections and decreases mortality and morbidity. It is recommended to vaccinate children with IEM with the same schedule for healthy children, but there are some precautions. The aim of this study is to investigate vaccination status and vaccine delays among children with IEM. Methods: This cross-sectional study evaluated 99 children with IEM. Patients who were diagnosed with IEM up to 18 years of age constituted the study population. Existing comorbid conditions, and additional diseases were questioned. Immunization rates and its relationship between clinical classification, existing comorbid conditions and additional diseases were assessed. Adverse events after vaccinations were questioned. Results: Among 99 patients with IEM, 14 had vaccine delays. The incidence of vaccine delay in patients in the stable group was significantly lower than sickest and chronic groups. There was statistically significant difference between comorbid and additional disease, and presence of vaccine delay. No adverse events after vaccinations were declared. Conclusion: Clinical characteristics of the disease, comorbid situations and additional diseases may be the reasons of vaccine delays in patients with IEM. Questioning the vaccination status at metabolism outpatient clinics, and opportunistic vaccinating during hospitalization if possible, may prevent vaccine delays of children with IEM.

COVID-19 Vaccine Hesitancy, Delay, and Refusal: Insufficient Knowledge, Complacency, and Distrust of the Medical System

Despite the relevance of COVID-19 vaccine hesitancy, delay, and refusal in relation to insufficient knowledge, complacency, and distrust of the medical system, only limited research has been conducted on this topic. Using and replicating data from The Aspen Institute, de Beaumont, Healthwatch Bexley, Hertfordshire County Council, Horizon Research, KFF, and Sabin Vaccine Institute, I performed analyses and made estimates regarding COVID-19 threat perceptions and vaccine hesitancy. The results of a study based on data collected from 6,400 respondents provide support for my research model. Descriptive statistics of compiled data from the completed surveys were calculated when appropriate. © 2021, Addleton Academic Publishers. All rights reserved.

"It's Like 1998 Again": Why Parents Still Refuse and Delay Vaccines.

We conducted a qualitative study from 2018 to 2019 to update the reasons why US parents’ refuse or delay vaccines. Four focus groups and 4 semi-structured interviews involving 33 primary care pediatric providers were conducted in Washington and Colorado. A thematic analysis was conducted to identify themes related to reasons for parental refusal or delay. Five predominant themes were identified: (1) vaccine safety, (2) relative influence of information sources, decision-makers, and timing, (3) low perceived risk of contracting vaccine-preventable disease, (4) lack of trust, and (5) religious objection. Vaccine safety was the theme mentioned most frequently by providers (N = 45 times by 26 providers) and religious objection to vaccination was referred to the least (N = 6 times by 6 providers). Provider-reported reasons for parental refusal or delay of childhood vaccines in 2018 to 2019 remain similar to those reported in previous studies.

The Welfare Cost of Vaccine Misallocation, Delays and Nationalism.

I calibrate an eco-epidemiological age-structured Susceptible-Infected-Recovered (SIR) model of the B.1.1.7 covid variant on the eve of the vaccination campaign in France, under a stop-and-go lockdown policy. Three-quarters of the welfare benefit of the vaccine can be achieved with a speed of 100,000 full vaccination per day. A 1-week delay in the vaccination campaign raises the death toll by approximately 2500, and it reduces wealth by 8 billion euros. Because of the large heterogeneity of the rates of hospitalization and mortality across age classes, it is critically important for the number of lives saved and for the economy to vaccinate older people first. Any departure from this policy has a welfare cost. Prioritizing the allocation of vaccines to the most vulnerable people save 70,000 seniors, but it also increases the death toll of younger people by 14,000. Vaccine nationalism is modeled by assuming two identical Frances, one with a vaccine production capacity and the other without it. If the production country vaccinates its entire population before exporting to the other, the global death toll would be increased by 20%. I also measure the welfare impact of the strong French anti-vax movement, and of the prohibition of an immunity passport.

Factors associated with delayed child vaccine during coronavirus disease-2019 pandemic

Background: Basic vaccinations are essential for child well-being and delaying these vaccines during coronavirus disease-2019 (COVID-19) pandemic will lead to vaccine-preventable diseases. This study was conducted to identify the factors that contribute to delay of vaccination during COVID-2019 pandemic and assess the prevalence of participants who have positive attitude towards continuing the vaccination during the pandemic. Methods: A cross-sectional study was conducted during May 2020 in all regions of Saudi Arabia through a self-administered intent-based questionnaire. Data were acquired from participants who take care of a child from birth to 4 years old, reside in Saudi Arabia. The questionnaire was structured to collect socioeconomic data, child information, vaccination information, and reasons of delaying vaccination schedule during the pandemic. Results: A total of 820 were included in the study, where 75.6% of participants in our survey had a positive attitude toward completing their children�s vaccination even during the COVID-19 pandemic. Participants elected not to continue the vaccine comprised 24.4% of the study. The main reasons for vaccine postponement were the fear of getting infected by COVID-19 virus if they visit health facilities (45.1%) and planning to delay vaccination till the pandemic ends (28.8%). There was a significant association between continuing vaccination during the pandemic and level of education, transportation, and age of the child. Conclusion: High level of education was strongly associated with continuing vaccination even in a such outbreak. Increasing the awareness will improve the vaccination coverage and prevent the appearance of preventable diseases.

Development Across the World on Vaccines for COVID-19: A Primer for Primary Care Physicians

The current Coronavirus Disease-2019 (COVID-19) pandemic needs no introduction. To save lives and revive the global economy, the need of the hour is a safe and effective vaccine which does not enhance viral disease. Scientists are using traditional, modern, and novel platforms to develop their vaccine candidates. Each platform has its pros and cons. Novel platforms will shorten our response time against biohazards of the future. Vaccine development is being rushed and we are optimistic that we will have a vaccine as early as mid-2021. World health organisation, governments, pharma giants, researchers, private companies, and philanthropists have joined their hands to fund the vaccine hunt and to ensure an equitable Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccine access to people all across the world. Our review highlights potential problems in vaccine development, plans for vaccine allocation, and hurdles for vaccine uptake. It also throws light on vaccine delays due to a lack of confidence in the safety and effectivity of the vaccine, along with difficulties to access a shot.

1383. Characterizing Real-world Patterns of Early Childhood Vaccination

BackgroundVaccine hesitancy is increasingly common, but more information is needed on patterns of childhood vaccination. We characterized patterns of vaccine delay among commercially-insured children in the U.S.MethodsUsing the IBM MarketScan Commercial Database, we identified infants who received a timely first dose of diphtheria-tetanus-acellular pertussis (DTaP) vaccine from October 2009 to June 2017. We used CPT codes to collect vaccine administration history on antigen, formulation, dose, and date. We ascertained injectable and oral vaccine antigens (DTaP, polio, pneumococcal conjugate, rotavirus, Haemophilus influenza type b (Hib), measles, mumps, rubella, varicella). Timely receipt was defined as concomitant administration of the CDC-recommended number of antigens during the following time windows: 2, 4, 6, and 12-15 months of age (grace period: -7, +21 days). We generated heat maps to illustrate age distributions at receipt of specific antigens and doses. We created Sankey diagrams to illustrate the number of antigens received concomitantly during each time window and depict transitions to different states over time (e.g., no vaccine delay to vaccine delay). For each antigen and dose, we estimated the cumulative incidence of receipt.ResultsAmong 1,066,216 eligible infants, the majority (84%) concomitantly received all 5 CDC-recommended antigens at 2 months of age while others only received 1 (1%), 2 (2%), 3 (4%) or 4 (9%) antigens. Many vaccinations were delayed – 30% and 39% of children did not receive all recommended antigens concomitantly at 4 and 6 months, respectively. The heat map shows wide variation in age at vaccination. For several antigens including Hib, measles, mumps, rotavirus, rubella, and varicella, the cumulative incidence increased steeply at ≥2 time points, suggesting vaccine delay for some infants (e.g., the first dose of Hib was administered to 85% of infants by 2 months of age, with subsequent small but distinct increases at 4, 6, 12, and 15 months of age).ConclusionUsing real-world data to study early childhood vaccination patterns, we observed evidence of substantial deviation from the CDC-recommended schedule. These results expand current knowledge on the magnitude and timing of antigen- and dose-specific vaccine delay on a population level.Disclosures Jason Newland, MD, MEd, FPIDS, Merck (Grant/Research Support)Pfizer (Other Financial or Material Support, Industry funded clinical trial) Leah McGrath, PhD, NoviSci, Inc. (Employee)

Vaccination timeliness and completeness among preterm and low birthweight infants: a national cohort study

ABSTRACT Vaccinating premature and low birthweight (LBW) infants according to chronological age has been found safe and effective. Although these infants are susceptible to infections, vaccinations are often delayed. We estimated vaccination coverage (VC) in preterm and LBW infants compared to term infants in a cohort study (2016 Israel birth cohort, n = 181,543) using the National Immunization Registry. Vaccinations included Hepatitis B, Diphtheria-Tetanus-acellular Pertussis-IPV-Haemophilus influenzae B, Oral Polio Bivalent, Rotavirus, Pneumococcal Conjugate, Measles-Mumps-Rubella-Varicella and Hepatitis A. Inclusion criteria: (1) born in Israel; (2) having a unique identifier (allowing data matching); and (3) surviving to 24 months. VC at 24 months and timeliness of vaccine doses were evaluated according to infants’ birthweight (BW) and gestational age (GA). Preterm infants (GA < 37 weeks) comprised 7.0% (n = 12,264); LBW infants (BW< 2500 g) were 7.7% (n = 13,950); BW was 1500–2499 g in 6.8%, 1000–1499 g in 0.6% and below 1000 g in 0.3%. Compared to normal birthweight (NBW) infants (BW≥2500 g), LBW infants showed delayed initiation of vaccinations. Odds ratio (OR) for delay: DTaP-IPV-Hib 1 OR = 1.26 [95%CI 1.19–1.33]; Rota 1, OR = 1.22 [95%CI 1.16–1.29]. Vaccination delay rates were higher among smaller new-borns (below 1000 g). At 24 months there was no significant difference regarding vaccination status. This national cohort VC analysis focused on preterm/LBW infants. Vaccinating preterm and LBW infants according to the recommended schedule induces protection against life-threatening infectious diseases. Vaccination initiation among LBW infants showed considerable delay. Health practitioners and parents should cooperate to improve timely vaccination initiation.

Study and analysis of vaccination and immunization in Brazil today

According to the World Health Organization, researchers estimate that the spread of vaccines has allowed worldwide life expectancy to increase by 30 years in the past two centuries. Despite these advances, there are major challenges to be overcome to expand immunization coverage. Currently, the Unified Health System (SUS) offers a total of 19 vaccines that protect against more than 40 diseases free of charge. Therefore, the objective of the study was to study and analyze the current state of Brazilian vaccination in relation to infectious diseases eradicated in the country. For the development of the work, data from the Ministry of Health, published scientific articles in the Google academic, SCIELO and PubMed databases, epidemiological bulletins, as well as relevant studies and reports published on websites and internet portals through the descriptors, vaccination in Brazil, vaccination delay in Brazil, vaccines available in the single system were used (SUS). Through this work, it is concluded that the lack of information in a set of other factors generates the non-vaccination of the population, resulting in the return of previously eradicated diseases.

Timeliness of immunisation with the pentavalent vaccine at different levels of the health care system in the Lao People’s Democratic Republic: A cross-sectional study

BackgroundThe timely administration of vaccines is considered to be important for both individual and herd immunity. In this study, we investigated the timeliness of the diphtheria-tetanus-whole cell pertussis-hepatitis B-Haemophilus influenzae type b (pentavalent) vaccine, scheduled at 6, 10 and 14 weeks of age in the Lao People’s Democratic Republic. We also investigated factors associated with delayed immunization.Methods1162 children aged 8–28 months who had received the full course of the pentavalent vaccine at different levels of the health care system were enrolled. Vaccination dates documented in hospital records and/or immunisation cards were recorded. Age at vaccination and time intervals between doses were calculated. Predictors for timely completion with the pentavalent vaccine at 24 weeks were assessed by bivariate and multivariable analyses.ResultsSeveral discrepancies in dates between vaccination documents were observed. In general, vaccination with the pentavalent vaccine was found to be delayed, especially in health care settings below the provincial hospital level. Compared to the central hospital level, less participants who were vaccinated at the district/health center level received the third dose by 16 (48% at the central hospital level vs. 7.1% at the district and 12.4% at the health center level) and 24 weeks of age (94.4% at the central hospital level vs 64.6% at the district-outreach and 57.4% at the health center level) respectively. In logistic regression analyses, lower education level of the mother as well as vaccination by outreach service, were independently associated with delayed completion of vaccination.ConclusionWe observed a general delay of vaccination, especially at lower ranked facilities, which correlated with indicators of poor access to health services. This highlights the need for further improving health equity in rural areas. Age-appropriate vaccination should become a quality indicator for the national immunization programme. In addition, we recommend further training of the health care staff regarding the importance of reliable documentation of dates.

Strengthening Vaccine Confidence and Acceptance in the Pediatric Provider Office.

Although vaccine acceptance and uptake are overall high among children in the United States, vaccine delays or refusals are a growing concern. Vaccine hesitancy is a challenge for the pediatric provider, given the diverse factors associated with hesitancy and the limited evidence on effective strategies for addressing vaccine hesitancy in the provider office. In this article, we review available evidence and approaches for vaccine communication, including the importance of using a whole-team approach, building trust, starting the conversation early, using a presumptive approach for vaccine recommendations, motivational interviewing with parents who have concerns for vaccines, and additional techniques for responding to parent questions. We also review organizational strategies to help create a culture of immunization in the practice, including evidence-based approaches for increasing vaccine uptake and efficiency. Although these communication approaches and organizational strategies are intended to reassure parents who are vaccine hesitant that all routine, universally recommended vaccines are safe and effective, they likely will take on increased significance as the development, implementation, and evaluation of coronavirus disease 2019 vaccines continue to unfold. [Pediatr Ann. 2020;49(12):e523-e531.].

Global Measles Epidemic Risk: Current Perspectives on the Growing Need for Implementing Digital Communication Strategies.

A safe vaccine against measles has been available and globally recommended since 1974. The World Health Organization established measles elimination as a goal for 2020 but, unfortunately, this objective has not been achieved yet and outbreaks still occur. Herd immunity, ie, a population immunity higher than 95%, is required to stop the measles virus transmission. Communication plays a crucial role in immunization strategy to obtain high coverage levels, as it helps to fight barriers against vaccination. Delay and refusal of measles vaccination have become widespread due to misinformation, fake news and barriers to effective communication. This phenomenon has been defined as “vaccine hesitancy” and is considered as one of the top ten risks for global health. The alleged association between measles vaccination and autism has caused a sharp decline in vaccination rates. In this current situation, mass communication integrated into public health policies is fundamental to sway people’s positive attitudes toward vaccination. Digital communication strategies based on social media and other internet platforms may represent useful tools to promote immunization and discourage skepticism and complement information provided by health-care professionals who have been considered as the most credible source on risk/benefits on vaccines for families. Digital communication strategies that may help supporting the measles elimination strategy include monitoring information needs online, integrating digital communication into immunization programs, involving a multidisciplinary group in communication, developing content that balances facts with positive messaging, using multiple communication channels. Further research activities should be promoted in the field of effective communication for immunization.

Vaccine Delay and Its Association With Undervaccination in Children in Sub-Saharan Africa

Improving the timeliness and completion of vaccination is the key to reducing under-5 childhood mortality. This study examines the prevalence of delayed vaccination for doses administered at birth and age 6 weeks, 10 weeks, 14 weeks, and 9 months and its association with undervaccination among infants in Sub-Saharan Africa. Pooling data across 33 Sub-Saharan Africa countries, vaccination timing and series completion were assessed for children aged 12-35 months who were included in the immunization module of the Demographic and Health Surveys conducted between 2010 and 2019. Survey design-adjusted logistic regression modeled the likelihood of not fully completing the basic immunization schedule associated with dose-specific delays in vaccination. Data were obtained and analyzed in May 2020. Among children with complete date records (n=70,006), the proportion of children vaccinated with delays by ≥1 month was high: 25.9% for Bacille Calmette-Guerin (at birth); 49.1% for the third dose of pentavalent combination vaccine (at 14 weeks); and 63.9% for the first dose of measles vaccines (at 9 months). Late vaccination was more common for children born to mothers with lower levels of educational attainment (p<0.001) and wealth (p<0.001). Controlling for place, time, and sociodemographics, vaccination delays at any dose were significantly associated with not completing the immunization schedule by 12 months (Bacille Calmette-Guerin: AOR=1.93, [95% CI=1.83, 2.02]; pentavalent 3: AOR=1.50 [95% CI=1.35, 1.64]; measles: AOR=3.76 [95% CI=3.37, 4.15]). Timely initiation of vaccination could contribute to higher rates of immunization schedule completion, improving the reach and impact of vaccination programs on child health outcomes in Sub-Saharan Africa. This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health.