Vaccination Sessions Research Articles

Influenza vaccination campaigns targeted at healthcare workers:results of four hospitals in Rome

Abstract Background Seasonal influenza vaccination (SIV) of health care workers (HCWs) is well recognized as a public health measure that can protect both HCWs from infection and patients from the risk of influenza complications. Nevertheless, vaccination coverage rates among this specific population result generally lower than the recommended target. With our study, we aimed to describe the activities and the outcomes of four different SIV campaigns targeted at HCWs and organized during the season 2018/2019 in four hospitals in Rome. Methods A cross-sectional study involving four teaching hospitals was performed. The collected data were synthetized into a set of descriptors and indicators, validated through a previous study that had involved the same Centers. Results The Medical Directorates, in collaboration with the University Hygiene and Public Health Units of the four hospitals organized different strategies: Hospital 1, 3 and 4 realized educational courses for HCWs and actively promoted the campaigns through e-mail invitations to all HCWs. As for the access to vaccination, all the hospitals provided a dedicated unit for SIV; Hospital 1 and Hospital 4 organized also on-site vaccination sessions in the hospital wards, that required a large number of staff. The vaccination coverage rates resulted: 22.37% in Hospital 1, 18.10% in Hospital 4, 9.28% in Hospital 2 and 8,51% in Hospital 3. Conclusions Our results demonstrate that multi-activity campaigns, involving education, promotion and easy access to vaccination constitute an effective approach to reinforce the value of SIV. Our findings suggest that on-site vaccination may play a key role in determining a higher vaccination coverage. Key messages Multi-activity vaccination campaigns, involving education, promotion and easy access to vaccination constitute an effective approach to reinforce the value of seasonal influenza vaccination for HCWs. On-site vaccination may play a key role in determining a higher vaccination coverage.

A vaccination campaign in a Roma community in Rome: an experience of the Local Health Autority Roma1

Abstract Issue/problem About 8,000 Roma and Sinti live in the city of Rome, distributed in 33 settlements. This population is particularly at risk of health problems, due to social marginality and reduced access to health and social services. An important challenge for public health is therefore to guarantee and improve the right to health and the availability of health care. In Italy, a new vaccination law was approved in July 2017 and 10 vaccinations became mandatory for minors attending schools. Description of the problem In 2018 the District 14 of the Local Health Authority Rome1 (LHA Rome1) organized a vaccination campaign for the Roma and Sinti community being in its area. The aim of the campaign was to analyse the vaccination status of children under-18 living in the camp, based on the local police census data, crossed with the web based regional vaccination registry, to offer free vaccination for those without a regular status, in order to allow school attendance. Results Among 109 children living in the targeted Roma and Sinti camp, only 6 (5.5%) had a regular vaccination status according to the Italian law. Two different vaccination opportunity were offered to the community during 2018: a dedicated vaccination session in the local vaccination center, during which 6 children were vaccinated; four vaccination days offered directly at the Roma camp (a total of 53 children were vaccinated). At the end of 2018, the new Police census identified 114 minors resident in the camp instead of 109; of these, 48 (42.1%) had reached a regular vaccination status. Lessons Addressing hard-to-reach communities in order to improve the access to health and social services is one of the LHA objectives. The intervention performed in the Roma camp was also an opportunity to promote the importance of vaccination and to inform the target community about various LHA services, in particular maternal and infant services, including those for Temporarily Present Foreigners. Key messages The interventions performed straight into communities living in unfavorable health and social conditions are useful to improve the access to health and social services. Vaccination of people living in a social marginality is an important challenge for public health in order to guarantee specific protection measures and promoting the right to health.

A cross sectional study for assessment of immunization services and knowledge of vaccinator (ANM) on vaccination site (Session site) at district Etawah

Background: Improper coverage of the immunization facilities among various regions indicate out the need of assessing knowledge, attitude and practice (KAP) with regard to immunization among the vaccine handlers of the immunization session sites. Objective: Assessing the immunization services and knowledge of the vaccinator at various immunization session sites of the district Etawah. Setting: The study was conducted among Auxiliary Nurse Midwife (ANM) at vaccination (session) site of all Community Health Centers (CHCs) and Primary Health Centers (PHCs) in district Etawah. Data pertaining to the various observations of the immunization sites was collected using a semi-structured questionnaire.Result: In the present study it has been observed that most of the ANMs at the immunization sites of the district of Etawah, were found to be adequately educated and trained for maintaining vaccine at the sites. Moreover, most of the immunization sites in the district were found to have proper logistics and immunization services as well as proper condition of the vaccine vials. Most of the vaccine handlers were reported to have proper knowledge on vaccination procedures.Conclusion: Although most of the participants are trained once or twice but there are some specific sectors where the participants are needed to be informed and trained.

Implementation of the World\u2019s largest measles-rubella mass vaccination campaign in Bangladesh: a process evaluation

BackgroundGavi, the Vaccine Alliance, supported a mass vaccination Measles-Rubella Campaign (MRC) in Bangladesh during January–February 2014.MethodsWe conducted a mixed-method process evaluation to understand the successes and challenges in implementation of the MRC. We reviewed documents for the MRC and the immunization programme in Bangladesh; observed meetings, vaccination sessions, and health facilities; and conducted 58 key informant interviews, 574 exit interviews with caregivers and 156 brief surveys with stakeholders involved in immunization. Our theory of Change for vaccination delivery guided our assessment of ideal implementation milestones and indicators to compare with the actual implementation processes.ResultsWe identified challenges relating to country-wide political unrest, administrative and budgetary delays, shortage of transportation, problems in registration of target populations, and fears about safety of the vaccine. Despite these issues, a number of elements contributed to the successful launch of the MRC. These included: the comprehensive design of the campaign; strong partnerships between immunization authorities in the government system, Alliance partners, and civil society actors; and motivated and skilled health workers at different levels of the health system.ConclusionsThe successful implementation of the MRC in spite of numerous contextual and operational challenges demonstrated the adaptive capacity of the national immunization programme and its partners that has positive implications for future introductions of Gavi-supported vaccines.

Seasonal influenza vaccination among health-care workers: the impact of different tailored programs in four University hospitals in Rome

ABSTRACTSeasonal influenza vaccination (SIV) of health-care workers (HCWs) is recommended in most countries to protect them and their patients from infection. Although SIV can reduce the risk of influenza complications among vulnerable patients, vaccination uptake is generally unsatisfactory. The present study aimed to assess the impact of different programs in promoting SIV uptake among HCWs during the season 2017/2018 in four teaching hospitals in Rome. A multicentric cross-sectional study was carried out, in order to describe the four different campaigns and to assess their impact by identifying and developing a set of indicators that provide information about the vaccination services, the percentage of invited HCWs, the vaccinators’ workforce and the vaccination coverage rates.The hospitals organized different strategies: Hospital 1, 3 and 4 organized educational courses for HCWs and actively invited every single HCW through e-mail. All the hospitals organized a dedicated unit for influenza vaccination, and Hospital 1 added on-site vaccination sessions that required a large number of staff. Hospital 1 and hospital 4 registered a comparable vaccination coverage rate, 12.97% and 12.76%, respectively, while it was 6.88% in Hospital 2 and 4.23% in Hospital 3. Our indicators demonstrated to be effective and useful for analyzing the different SIV campaigns. The results suggest that the best practice to promote SIV among HCWs should include multiple approaches. Among those, an easy access to the vaccination site seems to play a key role in determining a higher vaccination coverage.

Short Message Service Reminders to Parents for Increasing Adolescent Human Papillomavirus Vaccination Rates in a Secondary School Vaccine Program: A Randomized Control Trial

PurposeIn Victoria (Australia), the human papillomavirus (HPV) vaccine is delivered within a state-wide secondary school vaccine program, administered by local government. This study aimed to test the hypothesis that sending a short message service (SMS) reminder to parents who had consented to their child's receiving the HPV vaccine would lead to greater uptake of the vaccine within the program. The secondary aim was to assess the effect of self-regulatory versus motivational message content in the SMS. MethodsA randomized control trial design was used across 31 schools within seven local government areas. Parents of 4,386 consented adolescents were randomized into three study conditions: motivational SMS versus self-regulatory SMS versus no SMS. Follow-up extended beyond the final school visit to the end of the calendar year to capture those who may have attended a catch-up vaccination session. ResultsOn the day of the final school visit, 85.71% of consented students in the control condition received the HPV vaccine, compared with 88.35% (2.64% point increase) in the motivational message condition, and 89.00% (3.29% point increase) in the self-regulatory message condition, χ2 (2, N = 4,386) = 8.31, p = .016. Both intervention messages were similarly effective at increasing vaccination rates. This effect was maintained in the extended follow-up period. ConclusionsThe trial findings supported the hypothesis that SMS reminders to parents/guardians would lead to greater uptake of the HPV vaccine in adolescents participating in school-based vaccination. Also, this effect was observed whether we used a motivational or self-regulatory message framework. Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN12617001307392). Registration Date: September 12, 2017. Retrospectively registered.

South African Undergraduate Health Science Students’ Knowledge, Attitudes, Practices and Preferences Regarding Vaccination

Abstract Background: South African universities lack comprehensive vaccination policies for undergraduate health science students, despite exposure to vaccine-preventable diseases during clinical training. We investigated health science students’ knowledge, attitudes and practices (KAP) of Stellenbosch University regarding vaccination and established their preferences for the delivery of a student vaccination programme. Methods: A 32-question survey regarding students’ KAP and preferences about vaccination was emailed to undergraduate health science students (n = 2472) between November 2017 and April 2018. Mean KAP scores and vaccination preferences were compared between medical and allied health students. Responses to three open-ended questions were coded by two independent researchers to identify emerging themes. Results: Questionnaires (n = 403) were completed by medical (79.8%) and allied health (20.2%) students. There was no difference between the mean K-scores of the two groups (6.8 vs 6.4/10 questions; p = 0.998). Students had positive attitudes to vaccination (mean A-score 4.1/7 questions) but felt that education regarding recommended vaccinations was lacking. Although students supported the idea of mandatory vaccinations, many raised concerns regarding access and affordability of vaccinations. The majority (90.3%) of students had completed or were completing their hepatitis B immunization series. There was widespread support for peer vaccination sessions and development of a webpage or mobile application to assist with scheduling of vaccinations. Conclusions: Undergraduate health science students support the introduction of an expanded vaccination policy. Additional educational content, vaccine accessibility and affordability are important issues to consider in the development of a health science student vaccination programme.

Achieving effective vaccination to optimise pig herd health

Vaccination is becoming increasingly important, particularly with the current pressures on the pig industry to reduce the use of antimicrobials. A number of factors contribute to a successful and effective vaccination session, not only for pig health but also for worker welfare. The timing of vaccination is crucial in ensuring the stimulation of an effective immune response to prevent disease outbreaks. Pig handling and duration of the session can also have an impact on the quality of vaccination. Data collected from vaccination sessions provides traceability and can be utilised when considering lung health and revising vaccination protocols on farms.

Targeted vaccination campaigns of teenagers after two clusters of serogroup B invasive meningococcal disease in Brittany, Northwest France, January to October 2017

Introduction In December 2016, three cases of invasive meningococcal disease (IMD) serogroup B, including two children from the same middle school (11 to 15-years-old pupils), occurred in the district Cotes-d’Armor (Brittany, France). They were all infected by the same strain (B: P1.7-2, 4:F5-9:cc162), covered by the vaccine Bexsero®. An expert committee decided to implement a vaccination campaign in the school according to national guidelines. Four months later, in April 2017, two additional cases due to the same strain occurred in a high school (16- to 19-years-old students) of the same area. A hyperendemic situation was reached (at least 4 cases and an attack rate > 3 per 100,000 within 52 weeks). Vaccination was then proposed to students of the high school and to everyone aged between 11 and 19 years living or studying in the area. Since the vaccine was licensed in France (2013), this was only the third such vaccination campaign with Bexsero®. Methods The targeted population of 11–19-years-old living or studying in the area included 8511 people: 579 in the middle school, 2007 in the high school and 5925 in community. Vaccination sessions were organized directly in the two schools (January and March 2017 in the middle school, May and June 2017 in the high school). A real time monitoring of the number of vaccinations was implemented in both schools. In the community, vaccines were made available in pharmacies and teenagers were vaccinated by general practitioners. Vaccination coverage was estimated from wholesale distributors’ data. A pharmacovigilance follow-up was set up to document adverse effects of the vaccine. Results The vaccination coverage was 84% for 1 dose and 79% for 2 doses in the middle school and 56% for 1 dose and 42% for 2 doses in the high school. In the community, the vaccination coverage was estimated at 36% for 1 dose and 27% for 2 doses. Considering all 11–19-years-old living or studying in the hyperendemic area, the vaccination coverage was estimated at 44% for 1 dose (3775 doses) and 36% for 2 doses (3082 doses). No severe adverse effect was reported. The vaccination campaigns finished in October 2017. Conclusions This experience, involving different public health actors, constitutes a reproducible approach for future targeted vaccination campaigns. The vaccination coverage was higher when vaccination sessions were organized within schools and lower in the community. The safety profile of Bexsero® is consistent with available data. No additional cases of the same strain occurred since the end of the campaigns in the area.

Assessment of vaccine wastage rates, missed opportunities, and related knowledge, attitudes and practices during introduction of a second dose of measles-containing vaccine into Cambodia’s national immunization program

IntroductionMissed opportunities for vaccination (MOV) can result in inadequate protection against disease. Although healthcare provider reluctance to open multi-dose, lyophilized vaccine vials (particularly the measles-containing vaccine [MCV]) for every eligible child due to concerns about wasting vaccine is a known reason for MOV, little is known about providers’ related attitudes and practices. MethodsIn 100 randomly selected health facilities and 24 districts of Cambodia, we surveyed healthcare providers and their district supervisors regarding routine vaccine administration and wastage knowledge and practices, and child caregivers (five per facility) regarding MOV. Vaccine stock management data covering six months were reviewed to calculate facility and district level wastage rates and vaccine usage patterns for six vaccines, including a recently introduced second dose of MCV (MCV2). ResultsResponse rates were 100/100 (100%) among facility staff, 48/48 (100%) among district staff, and 436/500 (87%) among caregivers. Mean facility-level wastage rates varied from 4% for single-dose diphtheria-tetanus-pertussis-hepatitis B-Haemophilus influenzae type b vaccine to 60% for 10-dose MCV; district-level wastage rates for all vaccines were 0%. Some vaccines had lower wastage rates in large facilities compared to small facilities. The mean MCV wastage rate was the same before and immediately after MCV2 introduction. Providers reported waiting for a mean of two children prior to opening an MCV vial, and 71% of providers reported offering MCV vaccination less frequently during scheduled vaccination sessions than other vaccines. Less than 5% of caregivers reported that their child had been turned away for vaccination, most frequently (65%) for MCV. DiscussionAlthough the MCV wastage rate in our study was in line with national targets, providers reported waiting for more than one child before opening an MCV vial, contrary to vaccine management guidelines. Future research should explore the causal links between provider practices related to vaccine wastage and their impact on vaccination coverage.

Multi-dose vial administration with non-stationary demand and delayed service

To vaccinate patients arriving to clinics in remote locations, clinicians reconstitute vials containing multiple doses of lyophilized vaccines, but often only partially use the vials by the end of the vaccination session. The unused doses are discarded and termed “open vial waste”. Current practice is typically to vaccinate all patients as long as there is inventory on-hand, which results in significant open vial waste. Previous work on determining dynamic vaccine administration policies to minimize open vial waste makes the simplifying assumptions that unvaccinated customers are lost and that the arrival rate is both unaffected by the administration policy and constant throughout the replenishment cycle. We relax these assumptions by considering a positive probability of return for unvaccinated patients and by incorporating non-stationary arrival rates throughout the replenishment cycle as well as within each session. To study the impact of these enhancements, we perform extensive numerical experiments at the clinic level for a single replenishment cycle and then extrapolate to multiple clinics and the worldwide system on an annual basis. The results indicate potential savings on the order of millions of doses per year.

MEASLES OUTBREAK IN A RURAL AREA OF A DEVELOPING COUNTRY: A CASE CONTROL STUDY

Background: Measles is highly contagious vaccine preventable disease (VPD), and a major public health problem considered as leading cause of morbidity and mortality in developing countries like Pakistan. An outbreak of measles was reported in Sharifabad Islamabad on 15th of April 2017, and an investigation was launched to assess the magnitude of outbreak, evaluate risk factors and recommend control measures. Methods: A comprehensive house to house active case search along with vaccine coverage survey was conducted from April 19-22, 2017. A case was defined as "onset of maculopapular rash with fever in a resident of Sharifabad with at least one of the following signs/ symptoms, Coryza, Conjunctivitis, Cough, Otitis media or Pneumonia present in between 19 March to 22nd April 2017". Four age & sex matched controls were selected from the neighborhood. Data was collected through interview method using structured questionnaire and vaccination coverage was determined by using Epi survey form. Blood samples were sent for laboratory confirmation. Results: A total of eight cases were identified through active case finding while three were reported by local practitioner. Mean age of cases were 20 months (range 8-36 months). Severely affected age-group was 1-2 years with attack rate of 46%. Around two-third (64%) of cases and a few (16%) of controls were unvaccinated against measles. Contact with measles patient [OR 25.2, CI 3.9-160.1, P=0.00], unvaccinated children [OR 9.2 CI 2.12-40.4, P=0.000], social misconception regarding vaccination [OR 7.8 CI 1.42-42.6, P=0.00], and distance from healthcare facility [OR 5.7 CI 1.15-28.35, P=0.02] were significant risk factors. Vaccine efficacy was 90%. Conclusion: Main reasons of the outbreak were contact with the cases, and low vaccination status. We recommended comprehensive measles vaccination and community awareness sessions. On our recommendations district health authority Islamabad carried out mop up of whole area.

Vaccine wastage in Nigeria: An assessment of wastage rates and related vaccinator knowledge, attitudes and practices.

The introduction of new vaccines highlights concerns about high vaccine wastage, knowledge of wastage policies and quality of stock management. However, an emphasis on minimizing wastage rates may cause confusion when recommendations are also being made to reduce missed opportunities to routinely vaccinate children. This concern is most relevant for lyophilized vaccines without preservatives [e.g. measles-containing vaccine (MCV)], which can be used for a limited time once reconstituted. We sampled 54 health facilities within 11 local government areas (LGAs) in Nigeria and surveyed health sector personnel regarding routine vaccine usage and wastage-related knowledge and practices, conducted facility exit interviews with caregivers of children about missed opportunities for routine vaccination, and abstracted vaccine stock records and vaccination session data over a 6-month period to calculate wastage rates and vaccine vial usage patterns. Nearly half of facilities had incomplete vaccine stock data for calculating wastage rates. Among facilities with sufficient data, mean monthly facility-level wastage rates were between 18 and 35% across all reviewed vaccines, with little difference between lyophilized and liquid vaccines. Most (98%) vaccinators believed high wastage led to recent vaccine stockouts, yet only 55% were familiar with the multi-dose vial policy for minimizing wastage. On average, vaccinators reported that a minimum of six children must be present prior to opening a 10-dose MCV vial. Third dose of diphtheria-tetanus-pertussis vaccine (DTP3) was administered in 84% of sessions and MCV in 63%; however, the number of MCV and DTP3 doses administered were similar indicating the number of children vaccinated with DTP3 and MCV were similar despite less frequent MCV vaccination opportunities. Among caregivers, 30% reported being turned away for vaccination at least once; 53% of these children had not yet received the missed dose. Our findings show inadequate implementation of vaccine management guidelines, missed opportunities to vaccinate, and lyophilized vaccine wastage rates below expected rates. Missed opportunities for vaccination may occur due to how the health system's contradicting policies may force health workers to prioritize reduced wastage rates over vaccine administration, particularly for multi-dose vials.

Assessment of immunization services at immunization sessions under Ghatnandur PHC area in Beed district

Background: It was realized that just providing vaccine to achieve targets without giving attention to quality of services doesn’t guarantee a reduction in disease morbidity & mortality. Operational challenges such as logistic supply and microplanning have to be taken into consideration There is also increasing need to ensure that providers stick to service delivery protocols to achieve better health outcomes. Therefore the Study was aimed to assess the immunization sessions. The objective of the study was to evaluate the immunization sessions for logistics and availability of health workers, in the study area.Methods: The study was carried in 21 Grampanchayats covered by Ghatnadur PHC. semi structured preformed questionnaire was used for evaluation. Immunization sessions were also studied for information provided regarding side effects of vaccines.Results: Availability of human resources and logistics for vaccination sessions was more than 80% at all vaccination sessions. Information about side effects was the loophole in vaccine delivery services. Message regarding side effects of vaccines was not conveyed to most of the population.Conclusions: Vaccine delivery services were good in study area. Information about side effects should be conveyed 100% to of the population. The study should be extended to larger area for generalization of results.

Mothers’ teething beliefs and treatment practices in Mansoura, Egypt

ObjectivesTo reveal mothers’ beliefs about signs and symptoms associated with teething and their treatment practices.Population and methodsA cross-sectional study done in Mansoura District on 457 mothers and their children with one or more erupted teeth. Mothers were interviewed during vaccination session at 25 chosen health facilities. Mothers were asked whether they agree or disagree about 24 signs and symptoms claimed to be associated with teething.ResultsOnly 1.8% reported no symptoms at the time of teething. Majority had correct knowledge related to bite fingers/objects (70.5%) and drooling (60.0%). Inaccurate knowledge was reported as gum rubbing (42.0%), gum swelling (47.0%), diarrhea (51.0%), fever (83.2%) and weight loss (46.0%). Only 16.8% of mothers have good knowledge about teething problems. Logistic regression analysis revealed that the independent predictors of good knowledge are higher education (AOR = 3.7), urban residence (AOR = 2.5) and having a first-born child (AOR = 5.5). Only 13.4% of mothers did not give any treatment for teething problems. Antipyretics and antibiotics were the most frequently given treatments (71.3%, and 24.3%; respectively).ConclusionsThe majorities of mothers had low knowledge about teething problems and gave unnecessary treatments.

Vaccination Safety Standards Practiced in Selected Primary Health Centers in Jazan, KSA

Vaccine is a biological preparation that improves immunity to specific diseases. Morbidity and mortality declined where immunization are practiced. Vaccine safety is prime for community, manufacturer, immunization providers and recipient of vaccines. This study aims to contribute to the application of best practices on vaccine safety among nurses. After determining the vaccination safety standards observed, strategies and proposals to improve techniques in vaccination safety through education and training were offered. The quantitative-descriptive method was used. Data were supplied by 100 nurses who were in the Primary Health Care centers in Jazan City KSA. Questionnaire used was patterned from the tool on evaluating vaccination practices contained in the Quality Assurance in Primary Health Care Manual for Nurses in Saudi Arabia. Weighted Mean and Chi- Square test for a one-sample case were used to treat the data obtained. Result of the study showed that nurses’ responses on vaccine safety standards practiced were significant but their responses on routine vaccine practice were not significant. Vaccination safety standards were observed and practiced along resources and structures, procedures in vaccination and immunization session guidelines while knowledge on routine vaccine practice was observed sometimes. Responses of the nurses showed correlation on resources and structures, procedures on vaccination and immunization guidelines but not on knowledge on routine vaccine practice. The strategies and proposals laid down may improve techniques in vaccination safety through education and training.

Cold-Chain Adaptability During Introduction of Inactivated Polio Vaccine in Bangladesh, 2015.

Background.Introduction of inactivated polio vaccine creates challenges in maintaining the cold chain for vaccine storage and distribution.Methods.We evaluated the cold chain in 23 health facilities and 36 outreach vaccination sessions in 8 districts and cities of Bangladesh, using purposive sampling during August–October 2015. We interviewed immunization and cold-chain staff, assessed equipment, and recorded temperatures during vaccine storage and transportation.Results.All health facilities had functioning refrigerators, and 96% had freezers. Temperature monitors were observed in all refrigerators and freezers but in only 14 of 66 vaccine transporters (21%). Recorders detected temperatures >8°C for >60 minutes in 5 of 23 refrigerators (22%), 3 of 6 cold boxes (50%) transporting vaccines from national to subnational depots, and 8 of 48 vaccine carriers (17%) used in outreach vaccination sites. Temperatures <2°C were detected in 4 of 19 cold boxes (21%) transporting vaccine from subnational depots to health facilities and 14 of 48 vaccine carriers (29%).Conclusions.Bangladesh has substantial cold-chain storage and transportation capacity after inactivated polio vaccine introduction, but temperature fluctuations during vaccine transport could cause vaccine potency loss that could go undetected. Bangladesh and other countries should strive to ensure consistent and sufficient cold-chain storage and monitor the cold chain during vaccine transportation at all levels.

Impact of an Intervention to Use a Measles, Rubella, and Polio Mass Vaccination Campaign to Strengthen Routine Immunization Services in Nepal.

BackgroundThe potential to strengthen routine immunization (RI) services through supplementary immunization activities (SIAs) is an important benefit of global measles and rubella elimination and polio eradication strategies. However, little evidence exists on how best to use SIAs to strengthen RI. As part the 2012 Nepal measles-rubella and polio SIA, we developed an intervention package designed to improve RI processes and evaluated its effect on specific RI process measures.MethodsThe intervention package was incorporated into existing SIA activities and materials to improve healthcare providers’ RI knowledge and practices throughout Nepal. In 1 region (Central Region) we surveyed the same 100 randomly selected health facilities before and after the SIA and evaluated the following RI process measures: vaccine safety, RI planning, RI service delivery, vaccine supply chain, and RI data recording practices. Data collection included observations of vaccination sessions, interviews with the primary healthcare provider who administered vaccines at each facility, and administrative record reviews. Pair-matched analytical methods were used to determine whether statistically significant changes in the selected RI process measures occurred over time.ResultsAfter the SIA, significant positive changes were measured in healthcare provider knowledge of adverse events following immunization (11% increase), availability of RI microplans (+17%) and maps (+12%), and awareness of how long a reconstituted measles vial can be used before it must be discarded (+14%). For the SIA, 42% of providers created an SIA high-risk villages list, and >50% incorporated this information into RI outreach session site planning. Significant negative changes occurred in correct knowledge of measles vaccination contraindications (−11%), correct definition for a measles outbreak (−21%), and how to treat a child with a severe adverse event following immunization (−10%). Twenty percent of providers reported cancelling ≥1 RI sessions during the SIA. Many RI process measures were at high proportions (>90%) before the SIA and remained high afterward, including proper vaccine administration techniques, proper vaccine waste management, and availability of vaccine carriers and vaccine registers.ConclusionsFocusing on activities that are easily linked between SIAs and RI services, such as using SIA high-risk village list to strengthen RI microplanning and examining ways to minimize the impact of an SIA on RI session scheduling, should be prioritized when implementing SIAs.

Equity and immunization supply chain in Madagascar

Vaccination rates have improved in many countries, yet immunization inequities persist within countries and the poorest communities often bear the largest burden of vaccine preventable disease. Madagascar has one of the world’s largest equity gaps in immunization rates. Barriers to immunization include immunization supply chain, human resources, and service delivery to reflect the health system building blocks, which affect poor rural communities more than affluent communities. The Reaching Every District (RED) approach was revised to address barriers and bottlenecks. This approach focuses on the provision of regular services, including making cold chain functional. This report describes Madagascar’s inequities in immunization, its programmatic causes and the country’s plans to address barriers to immunization in the poorest regions in the country. MethodsTwo cross-sectional health facility surveys conducted in November and December 2013 and in March 2015 were performed in four regions of Madagascar to quantify immunization system barriers. FindingsOf the four regions studied, 26–33% of the population live beyond 5km (km) of a health center. By 2015, acceptable (fridges stopped working for less than 6days) cold chains were found in 52–80% of health facilities. Only 10–57% of health centers had at least two qualified health workers. Between 65% and 95% of planned fixed vaccination sessions were conducted and 50–88% of planned outreach sessions were conducted. The proportion of planned outreach sessions that were conducted increased between the two surveys. ConclusionMadagascar’s immunization program faces serious challenges and those affected most are the poorest populations. Major inequities in immunization were found at the subnational level and were mainly geographic in nature. Approaches to improve immunization systems need to be equitable. This may include the replacement of supply chain equipment with those powered by sustainable energy sources, monitoring its functionality at health facility level and vaccination services in all communities.

The clinical spectrum of severe acute malnutrition in children in Cameroon: a hospital-based study in Yaounde, Cameroon.

Severe acute malnutrition (SAM) is a major health problem, and the cause of more than half of childhood deaths in children less than 5 years in developing countries. Globally, 20 million children under 5 years of age are severely malnourished according to the World Health Organization (WHO). In Cameroon, the prevalence of SAM remains high and estimated at 1.9% in 2011 and 1.3% in 2014. The aim of this study was to determine the epidemiology, clinical aspects and outcome of SAM at the Yaounde Gynaeco-Obstetric and Pediatric Hospital (YGOPH). We retrospectively reviewed the medical records of children hospitalized in the YGOPH for SAM over a period of 8 1/2 years (from September 2006 to March 2015). We included the medical records of children under 15 years of age who were hospitalized in the pediatric unit of the YGOPH for the management of SAM. Data was collected using a data entry form and was analyzed with Epi info version 3.5.4 software. Data was considered statistically significant for P less than 0.05. The prevalence of SAM was 2.72%. The median age was 9 months (range, 23 days-112 months). The most represented age group was 6 to 12 months with 34.6% of the children. The most frequent symptoms on admission were: wasting (58.1%) and fever (53.6%). The mean interval between the onset of symptoms and admission was 30.36 days. Marasmus was the most frequent clinical form of SAM observed in 88.8% of the children. Respiratory tract infections were the most common comorbidities and were present in 45 patients (25.1%), followed by malaria in 15.1% of cases. The sero-prevalence of human immuno deficiency virus (HIV) was 43.75% amongst the 32 children whose HIV status was known. Dehydration was the most frequent complication, with an occurrence of 29.6%. A total of 58.7% of patients were discharged following clinical improvement and the mortality rate was 15%. The average duration of hospitalization was 8.25 days. SAM is a frequently encountered pathology in this context with a high mortality, thus the need to step up prevention strategies. Health education during pediatric consultations and vaccination sessions on the appropriate feeding of the young infant and the child should be reinforced.