Vaccination Sessions Research Articles

Multiple cohort HPV vaccination in Zimbabwe: 2018–2019 program feasibility, awareness, and acceptability among health, education, and community stakeholders

IntroductionZimbabwe introduced human papillomavirus (HPV) vaccine nationally in May 2018, targeting multiple cohorts (girls aged 10–14 years) through a school-based vaccination campaign. One year later, the second dose was administered to the multiple cohorts concurrently with the first dose given to a new single cohort of girls in grade 5. We conducted cross-sectional surveys among health workers, school personnel, and community members to assess feasibility of implementation, training, social mobilization, and community acceptability. MethodsThirty districts were selected proportional to the volume of the HPV vaccine doses delivered in 2018; two health facilities were randomly selected within each district. One health worker, school health coordinator, village health worker, and community leader were surveyed at each selected health facility and surrounding area during January-February 2020, using standard questionnaires. Descriptive analysis was completed across groups. ResultsThere were 221 interviews completed. Over 60% of health workers reported having enough staff to carry out vaccination sessions in schools while maintaining routine vaccination services in health facilities. All school health coordinators felt the HPV vaccine should be delivered in schools in the future. Knowledge of the correct target cohort eligibility decreased from 91% in 2018 to 50% in 2020 among health workers. Understanding of HPV infection and use of HPV vaccine for cervical cancer prevention was above 90% for all respondents. Forty-two percent of respondents reported hearing rumors about the HPV vaccine, primarily regarding infertility and safety. ConclusionsFindings demonstrate the presence of highly knowledgeable staff at health facilities and schools, strong community acceptance, and a school-based HPV program considered feasible to implement in Zimbabwe. However, misunderstandings regarding target eligibility and rumors persist, which can impact vaccine uptake and coverage. Continued social mobilization efforts to maintain community demand and training on eligibility were recommended. Integration, partnerships, and resource mobilization are also needed to ensure program sustainability.

Perceptions of childhood vaccination practices among beneficiaries and healthcare service providers in slums under the national immunization program of India: a qualitative study

PurposeA qualitative study can help in understanding the unpolluted perspectives of key stakeholders involved in the vaccination practices and can explore vital factors that could influence vaccination-related behaviors and their utilization. This study aims to document the perceptions of caretakers, community members and healthcare service providers related to childhood vaccination practices in slums under the national immunization program (NIP) of India.Design/methodology/approachThis was a qualitative community-based cross-sectional study. Focus group discussions with caretakers, community members and healthcare service providers were used to build a holistic, detailed description and analysis of the factors associated with childhood vaccination practices within its real-world context.FindingsLack of awareness, fear of adverse events following immunization, inappropriate timing of vaccination sessions, loss of daily earnings, migration, lack of good behavior of health staffs, shortage of logistics and vaccines, limited resources and infrastructures and high expectations of beneficiaries were some of the vital barriers impacting vaccination practices in slums.Research limitations/implicationsThough this study provides significant good information on the indicators that can be considered to improve the vaccination practices in any slum settings, it has is also a limitations too due to its setting. Therefore, one needs to be cautious while generalizing these results to other settings like rural. In addition, Though we believe that these strategies could be useful in any setting, it is also important to tailor these observations them as per the need of the society and the population. Also, this is a self-reported qualitative study and therefore the perspectives reported in this study need to be taken with caution. Further, low vaccination, poor awareness, compromised healthcare services, high expectations could be considered as a stigma/fear among the responders and therefore there is always a chance of underreporting. Thus, it would be important in future to conduct a study involving a broader group of people in society and to establish factors associated with the vaccination coverage. that can help in improvement of vaccination.Originality/valueInitiatives such as regular interactions at different levels, effective communication including reminders, behavior interventions, the continued supply of vaccines and logistics, additional resources for the vaccination program, incentives and recognition, extended sessions and people-friendly healthcare delivery system could be helpful to strengthen the routine vaccination practices in slums.

Tracking Demographic Movements and Immunization Status to Improve Children's Access to Immunization (TDM-IAI): Protocol for a Field-Based Randomized Controlled Trial.

BackgroundIn Cameroon, the coverage, completeness, and timeliness of the Expanded Programme on Immunization (EPI) vaccines administration in children have remained heterogeneous and below the national and districts targets in several districts. In an effort to solve this problem, many interventions have been tested but none has shown significant improvement of the situation.ObjectiveThis trial aims to test whether involving Community Volunteers to assess children vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions can improve children vaccination timeliness, completeness and coverage.MethodsCommunities of the Foumban Health district, West region of Cameroon will be selected and assigned to either intervention or control groups using a restricted randomization of 2. In the intervention group, one Community Volunteer per community will be trained to visit households and record EPI-targeted children in a register, record their demographic movements, and assess their immunization status monthly for a year. The information recorded will be snapped and sent to the competent health center immunization team through WhatsApp. These will be used to plan and implement monthly community catch up immunization sessions in collaboration with the community volunteer. In the control group, the routine immunization sessions will be conducted with health centers organizing either weekly vaccination sessions for communities situated not farther than 5 kilometers away from the health facility or monthly vaccination sessions in communities situated more than 5 kilometers away from the health center. Baseline, mid-term and end-line surveys will be conducted to assess and compare immunization coverage, timeliness, and completeness.ResultsFunded in 2018, data collection started in 2018 and has been completed. Data analysis and reporting are ongoing.ConclusionsThis trial is expecting to test an innovative approach to improving children’s immunization timeliness, completeness and coverage of immunization by tracking EPI targeted population vaccination status and denominator at household level and building collaboration between the community and health facilities vaccination teams to organize monthly community-based response vaccination sessions. This intervention is expected to improve children sustainable access to EPI vaccination as it offers assessing and responding to their immunization needs at monthly basis using low cost local human resources.Trial RegistrationPan African Clinical Trials Registry ID PACTR201808527428720; tinyurl.com/u058qnseInternational Registered Report Identifier (IRRID)DERR1-10.2196/21734

Impact of the SARS-CoV-2 Pandemic on Routine Immunization Services: Evidence of Disruption and Recovery From 169 Countries and Territories

Background: The SARS-CoV-2 pandemic has revealed the vulnerability of immunization systems worldwide, although the scale of these disruptions has not been described at a global level. Methods: This report synthesized data representing 169 countries and territories. Data sources included administered vaccine dose data from January-December 2019 and 2020, WHO Regional office reports, and the WHO-led pulse survey administered in April and June 2020. Results were expressed as frequencies and proportions of respondents or reporting countries. Vaccine doses administered data were weighted by the population of surviving infants per country. Findings: A decline in the number of DTP3 and MCV1 doses administered in the first half of 2020 was noted. The nadir was observed in April 2020, when 35% fewer DTP3 doses were administered globally, ranging from 10% in Africa to 58% in South East Asia. Recovery of vaccinations began by June 2020 and continued into late 2020. WHO regional offices reported significant disruption to routine vaccination sessions in April 2020, related to interrupted vaccination demand, and supply, including reduced availability of the health workforce. Pulse survey analysis revealed that 69% of countries experienced disruption in outreach services compared to 44% countries with disrupted fixed-post immunization services. Interpretation: The marked magnitude and global scale of immunization disruption evokes the dangers of vaccine-preventable disease outbreaks in the future. Trends indicating partial resumption of services highlight the urgent need for ongoing assessment of recovery, catch-up vaccination strategy implementation for vulnerable populations, and ensuring vaccine coverage equity and health system resilience. Funding: World Health Organization and U.S. Agency for International Development (USAID). Conflict of Interest: We declare no competing interests.

Influenza vaccination strategies for 2020-21 in the context of COVID-19.

BackgroundInfluenza vaccination prevents people from influenza-related diseases and thereby mitigates the burden on national health systems when COVID-19 circulates and public health measures controlling respiratory viral infections are relaxed. However, it is challenging to maintain influenza vaccine services as the COVID-19 pandemic has the potential to disrupt vaccination programmes in many countries during the 2020/21 winter. We summarise available recommendations and strategies on influenza vaccination, specifically the changes in the context of the COVID-19 pandemic.MethodsWe searched websites and databases of national and international public health agencies (focusing on Europe, North and South America, Australia, New Zealand, and South Africa). We also contacted key influenza immunization focal points and experts in respective countries and organizations including WHO and ECDC.ResultsAvailable global and regional guidance emphasises the control of COVID-19 infection in immunisation settings by implementing multiple measures, such as physical distancing, hand hygiene practice, appropriate use of personal protective equipment by health care workers and establishing separate vaccination sessions for medically vulnerable people. The guidance also emphasises using alternative models or settings (eg, outdoor areas and pharmacies) for vaccine delivery, communication strategies and developing registry and catch-up programmes to achieve high coverage. Several novel national strategies have been adopted, such as combining influenza vaccination with other medical visits and setting up outdoor and drive through vaccination clinics. Several Southern Hemisphere countries have increased influenza vaccine coverage substantially for the 2020 influenza season. Most of the countries included in our review have planned a universal or near universal influenza vaccination for health care workers, or have made influenza vaccination for health care workers mandatory. Australia has requested that all workers and visitors in long term care facilities receive influenza vaccine. The UK has planned to expand the influenza programme to provide free influenza vaccine for the first time to all adults 50-64 years of age, people on the shielded patient list and their household members and children in the first year of secondary school. South Africa has additionally prioritised people with hypertension for influenza vaccination.ConclusionsThis review of influenza vaccination guidance and strategies should support strategy development on influenza vaccination in the context of COVID-19.

Measles outbreak investigation in Kambia District, Sierra Leone-2018

Background: Measles, an acute highly infectious viral disease, remains one of the leading causes of childhood morbidity and mortality worldwide. Despite the availability of safe and effective vaccines, measles cases have been reported in Sierra Leone. On 29 October 2018, the Kambia district health management team was notified of a suspected measles outbreak. On 1 November 2019, we investigated the outbreak to confirm the diagnosis, assess the magnitude, identify potential risk factors, and institute control measures. Methods and materials: We defined a suspected case as any person with fever and maculopapular rash in Kambia district from 1st October 2018 and a probable case as any suspected case with epidemiologic link to a laboratory confirmed case. We reviewed medical records, interviewed parents, patients and collected blood samples for measles confirmation. We collected patients’ demographic, clinical and exposure history. We conducted active case search and needs assessment for measles reactive mass vaccination in the community. We conducted social mobilization and risk communication. Results: A total of 91 cases (14 laboratory-confirmed and 77 probable cases) with no deaths reported. The overall Attack Rate (AR) was 24.2/100,000 persons, with the highest AR (119.6/100,000 persons) among the 6–11 months age group. The median age was 24.5 months (range 4–348), and 48 (56%) were females. Four out of seven chiefdoms were affected and Gibnleh-Dixon chiefdom was the most affected (AR = 274.9/100,000). The first four detected cases had travel history to the neighboring Republic of Guinea, where there was a confirmed measles outbreak, and three of the four affected villages are close to the border. The district administrative vaccination coverage was 87%, however, of the total 84 eligible cases, only two had vaccination cards. Conclusion: A measles outbreak was confirmed in Kambia district which shares a border with Guinea. The importation of measles cases in a susceptible community might have contributed to the spread of measles in the affected chiefdoms. A reactive mass vaccination targeting children aged six months to 15 years was conducted and achieved coverage of 100.8%. We recommended strengthening routine immunization through increased outreach vaccination sessions to communities, supplementary vaccination and to strengthen cross border surveillance and response framework.

Young women\u2019s autonomy and information needs in the schools-based HPV vaccination programme: a qualitative study

BackgroundUntil 2019, the English schools-based human papillomavirus (HPV) vaccination programme was offered to young women (but not young men) aged 12 to 13 years to reduce HPV-related morbidity and mortality. The aim of this study is to explore the extent to which young women were able to exercise autonomy within the HPV vaccination programme. We consider the perspectives of young women, parents and professionals and how this was influenced by the content and form of information provided.MethodsRecruitment was facilitated through a healthcare organisation, schools and community organisations in a local authority in the south-west of England. Researcher observations of HPV vaccination sessions were carried out in three schools. Semi-structured interviews took place with 53 participants (young women, parents of adolescent children, school staff and immunisation nurses) during the 2017/18 and 2018/19 programme years. Interviews were recorded digitally and transcribed verbatim. Thematic analysis was undertaken, assisted by NVivo software.ResultsYoung women’s active participation and independence within the HPV vaccination programme was constrained by the setting of vaccination and the primacy of parental consent procedures. The authoritarian school structure influenced the degree to which young women were able to actively participate in decisions about the HPV vaccination programme. Young women exercised some power, either to avoid or receive the vaccine, by intercepting parental consent forms and procedures. Reliance on leaflets to communicate information led to unmet information needs for young women and their families. Communication may be improved by healthcare professional advocacy, accessible formats of information, and delivery of educational sessions.ConclusionsStrategies to improve communication about the HPV vaccine may increase young people’s autonomy in consent procedures, clarify young people’s rights and responsibilities in relation to their health care services, and result in higher uptake of the HPV vaccination programme.Trial registrationISRCTN 49086105; Date of registration: 12 January 2018; Prospectively registered.

Smallpox scars in a 19th-century portrait at the Turku Art Museum.

During the 18th and early 19th century, smallpox (variola) was a leading cause of death, in children especially. In Finland, the percentage of deaths among children aged 1–10 years was between 20% and 30%.1 Sixty-five to 80% of survivors displayed facial pockmarks.2 To our knowledge, there are few identified artistic depictions of patients with variola. Painters usually refer to smallpox through portrait of Edward Jenner (James Northcote, Edward Jenner, 1803, National Gallery Portrait, London) or active vaccination sessions (Vicente Borrás y Abellá, Vacuna ción de niños. ca. 1900. Museo Nacional del Prado, Madrid),3 but rarely to patients. In 1626, Sustermans painted several portraits of Grand Duke Ferdinand the Second of the Medici at various stages of the disease.4 We report here about a portrait by Finnish painter Akseli Gallen-Kallela (1865–1931) from 1893 entitled ‘Pockmarked Boy from Savo’ (Rokonarpinen savolaispoika) that currently belongs to the Turku Art Museum collection. The artist painted the motif at Vehmersalmi, near Kuopio, in the Northern region of Savonia, along with some other canvases. The portrait depicts a Finnish boy in his teenage years, probably between his 10–15 years. He sits from ¾ and avoids looking directly at the spectator. His face is riddled with medial facial skin-coloured scars, and a slightly hypertrophic red scar is notable near the left nasolabial fold. The disfiguring scars left by the infection may explain the seeming sadness of his look (Fig. 1). The first country in Europe introducing obligatory smallpox vaccination was Bavaria in 1807. In Finland, Jennerian vaccination was carried out as early as in 1802 under the impulsion of the Finnish Economic Society (Finska Hushållningssällskapet). Along with other measures, vaccination led to a decline of smallpox mortality during the early 19th century in the country.1 Smallpox may be confused with other conditions, mainly chickenpox. It is also known that, at the time, common people in Finland used to call all skin eruptions rokko or rupuli (poxes) leading to possible misdiagnoses in case of deaths.1 It can be discussed whether the sitter had smallpox or chickenpox. However, smallpox was also easily diagnosable at the time and the last ‘great’ smallpox epidemics in Finland occurred in 1880–1882, 13 years before this portrait. The scars appear also quite deep compared to those from chickenpox; therefore, there is no reason to doubt the origins of the boy’s pockmarks. At the time of the painting, smallpox mortality dropped to 3.6/10 000 inhabitants,1 and at the turn of the 20th century, smallpox was not endemic in Finland anymore.1 Akseli Gallen-Kallela may have chosen to represent the marks of a soon by-gone disease in Finland. The author is indebted to Christian Hoffmann, Curator at the Turku Art Museum, Finland, for suggesting this artwork and additional input regarding the manuscript.

Vaccine Hesitancy among Master’s Degree Students in Nursing and Midwifery: Attitude and Knowledge about Influenza Vaccination

Influenza vaccination among healthcare workers may reduce morbidity and protect fragile patients. Most of the evidence concerning the vaccine hesitancy of healthcare workers reported lack of knowledge and wrong attitude. The aims of this study were to explore the knowledge and attitudes about influenza vaccination among master’s degree students in Nursing and Midwifery, and to evaluate the effectiveness of their involvement in the hospital vaccination campaign in order to increase intention to receive immunization. The students of nurses and midwives were involved in the vaccination sessions of the 2018–19 hospital campaign. They were recruited to complete an online survey. Students of the 2nd year (involved in the vaccination campaign) and the 1st year (not involved) were compared. Descriptive and inferential statistics were performed for data analysis. Students who intend to receive influenza vaccination in the following year registered a percentage of 83.6% and showed an overall attitude of 66.8%. The involvement of the students in the vaccination campaign led to a significant increase in their positive vaccination attitude (80.9% vs. 87.0%) and in their intention to receive flu vaccination in the following year (67.7% vs. 100%). A positive attitude towards vaccinations was observed by nurses and midwives. Their involvement in the planning and activities during the vaccination campaign could positively influence their opinions and intention to receive vaccination.

Targeted vaccination campaigns of teenagers after two clusters of B invasive meningococcal disease in Brittany, France, 2017

BackgroundIn December 2016, three cases of serogroup B invasive meningococcal disease, including two children from the same middle school (11 to 15 years old pupils), occurred in the department (administrative district) Côtes-d’Armor (Brittany, France). They were infected by a rare strain (B:P1.7–2,4:F5–9:cc162), covered by the 4CMenB vaccine (Bexsero®). Four months later, two cases due to the same strain occurred in a high school in the same area (15 to 19 years old students). In accordance with French recommendations, vaccination was proposed to students of both schools and to all individuals aged 11–19 years living or studying in the hyperendemic area. We describe these vaccination campaigns, from the alert to the impact evaluation.MethodsThe target population included 8884 people: 579 in the middle school, 2007 in the high school and 6298 in the community. In both schools, vaccination sessions were organized directly on site. In the community, teenagers were vaccinated by general practitioners. The vaccination campaign took place from May to October 2017. An active pharmacovigilance follow-up was set up to document adverse effects of the vaccine.ResultsConsidering the whole target population, the vaccination coverage was estimated at 43% for 1 dose and 34% for 2 doses. Higher vaccination coverage was observed in the schools (79% in the middle school and 42% in the high school for 2 doses) than in the community (27% for 2 doses). The reported adverse effects were consistent with the safety profile of the vaccine and no severe adverse effect was reported.ConclusionsThis vaccination campaign was the third one implemented with Bexsero® in France and constitutes a reproducible approach for future targeted vaccination campaigns. No additional cases of the same strain have occurred since the end of the campaigns in the area.

The vaccination registry of the local health company (ASL) Roma 4

Abstract Issue The regional vaccination of Lazio (AVR) and the ASL vaccination registries(AVA) that feed it, have had to adapt to the directions of national vaccination registry. The ASL Roma 4 added other implementations. Description of the Problem L'AVA must, first of all, allow easy search of subjects, defaulters and vaccination coverage for various filters but it can also facilitate the recording and analysis activity. Results The provision of barcodes allows the prompt search of subjects, the check of tax code and AIC codes of vaccines. The digital signature of the privacy and consent forms and anamnesis, taken from the “Guide to contraindications to vaccinations” directly available, allows the elimination of the paper. The possibility to go directly to AVR allows the registration of vaccinations made in other ASL. In addition, the AVA allows the compilation of the adverse event reporting form and vaccine management. The link with the portal on the ASL website allows users to download the vaccination certificate. Important is the possibility to send SMS before vaccination deadlines or appointments. The SMART-SMS allows sending videos or photos and manage a short link (http://tiny.cc/XXX) to an information page on ASL website, as well as user response SMS, that can also directly change appointments. Lessons The dematerialization of the forms leds to a greater compliance with the procedures, a more accurate anamnesis and the streamling of the vaccination session, the SMS bring greater compliance of users and an increase in vaccination coverage. The use of mobile analytics tools allows monitoring of vaccination campaigns. Key messages The dematerialization of the forms in the vaccination registry leds to a greater compliance with the procedures, a more accurate anamnesis and the streamling of the vaccination session. The ability to send SMS through the vaccination registry brings greater compliance of users and an increase in vaccination coverage.

Influenza vaccination among pregnant women: increasing awareness and coverage

Abstract Influenza is a serious public health issue and pregnant women are one of the categories at higher risk of complications. Vaccination represents a safe and effective tool for prevention but the importance is not well perceived and the coverage is low (ECDC: 25% median in 2016/17). A program of education and free vaccination has been proposed to pregnant women following birthing classes. The aim was to increase pregnant awareness and to increase vaccination coverage of both parents. Classes about vaccinations, their timing and efficacy were given and a dedicated ambulatory operating twice a month during the flu season was set up. After the classes, the women were addressed to the ambulatory to be vaccinated. Vaccination was offered to the partners of the pregnant as well. General data, anamnesis and data about previous vaccinations were asked and then entered into a database. The number of women participating to the birthing classes from October 2019 to January 2020 was 119. Of those, from the beginning of the vaccination sessions on November 14th 2019 until January 16th 2020, 46 were vaccinated in the dedicated ambulatory (plus 2 in the resident ambulatory of the hospital). The compliance to vaccination was 40.34%. An additional number of 39 partners was also vaccinated. November was the month with the highest number of people vaccinated (20 women and 14 partners), while January had the lowest (7 women and 8 partners). As expected a higher number of people got vaccinated at the beginning of the flu season. A considerable number of partners decided to vaccinate, showing the parents understanding of the importance of herd immunity. Sensitising the women towards vaccination and increasing their awareness is crucial to improve women and new-borns' health status. Even though the compliance was considerable, a lot of work has to be done to improve vaccination coverage and to make the importance of vaccination clear. Key messages Providing a programme of sensitisation could improve influenza vaccination coverage. The compliance, although satisfactory, can be further improved providing different and steady educational strategies.

HEALTH WORKER AND CAREGIVER INTERACTION DURING CHILD VACCINATION SESSIONS AT HEALTH FACILITIES IN SOMALI REGION OF ETHIOPIA: A QUALITATIVE STUDY

Abstract Introduction: Somali Region is one of the largest region in Ethiopia which has performed persistently low with immunization coverage. communication during vaccination sessions at health facilities is one of the key factors that influence caregiver’s decision to bring back their children for vaccination. The Objective of this study was to evaluate health worker and caregiver interaction during immunization session and identify communication gaps in Somali region Material and Methods: This was a cross sectional qualitative study. The study was carried out using in depth interview with health workers responsible for vaccination, observation of vaccinator and caregiver interaction during immunization session and exit interview of caregivers who brought their children for vaccination or whose child was vaccinated at the health facility. Results: Health workers responsible for vaccination in twelve health facilities from central and remote part of the region were interviewed. A total of 63 vaccination sessions in the 12 health facilities were observed and caregivers were interviewed on exit. Most caregivers described the vaccinators as friendly and supportive. Some mothers who did not bring the immunization card with them were returned with out child getting the service. The return date for vaccination was written on immunization card in most cases. Most caregivers do not identify vaccines by name or purpose, however they all want their children get all vaccines as recommended by health workers. Conclusion Health worker do not communicate required information for continued use of immunization service at health facilities during vaccination session. caregiver interaction in Somali region will need to be improved though training of health workers on immunization basics and communication

Pattern of infants' feeding and weaning in Suez Governorate, Egypt: an exploratory study.

Breastfeeding and proper weaning contribute to achievement of the Sustainable Development Goals. In Egypt, by age 4-5 months, only 13% of infants are exclusively breastfed. A survey conducted in Egyptian hospitals concluded that many of the 10 steps to support successful breastfeeding were not executed correctly and other steps were not executed at all. To explore the patterns of feeding and weaning among infants in Egypt, and identify their determinants, to improve practice and promote children's nutritional status. A cross-sectional analytical study of 333 mother-infant pairs attending two primary healthcare (PHC) centres for vaccination sessions between April 2017 and June 2018. Mothers were interviewed using a structured questionnaire. Almost all infants were born in hospitals. Exclusive breastfeeding was not widely practiced. Prelacteal feeding was a common malpractice. The majority of mothers initiated artificial feeding during the first month of life. Rural mothers tended to introduce different foods earlier than urban mothers did. Minimum dietary diversity was achieved by 50.9% of urban infants aged ≥ 6 months (≥ 4 food groups), compared with 25.9% of rural infants. Minimum recommended meal frequency for age was fulfilled for 51.9% of urban and 29.6% of rural infants. More than 85% of mothers expressed their need for additional knowledge, and more than half identified the PHC centre as the appropriate source for information. Our study reflects deficiency in maternal practice regarding breastfeeding and weaning, despite being regular visitors to the PHC centre.

Assessment of VaxTrac electronic immunization registry in an urban district in Sierra Leone: Implications for data quality, defaulter tracking, and policy

BackgroundIn 2016, the Sierra Leone Ministry of Health and Sanitation (MoHS) piloted VaxTrac, an electronic immunization registry (EIR), in an urban district to improve management of vaccination records and tracking of children who missed scheduled doses. We aimed to document lessons learned to inform decision-making on VaxTrac and similar EIRs’ future use. MethodsTen out of 50 urban health facilities that implemented VaxTrac were purposively selected for inclusion in a rapid mixed-method assessment from November to December 2017. For a one-month period, records of six scheduled vaccine doses among children < 2 years old in VaxTrac were abstracted and compared to three paper-based records (register of under-two children, daily tally sheet, and monthly summary form). We used the under-two register as the reference gold standard for comparison purposes. We interviewed and observed 10 heath workers, one from each selected facility, who were using VaxTrac. ResultsOverall, VaxTrac captured < 65% of the vaccine doses reported in the paper-based sources, but in the largest health facility VaxTrac captured the highest number of doses. Two additional notable patterns emerged: 1) the aggregated data sources reported higher doses administered compared to the under-two register and VaxTrac; 2) data sources that need real-time data capture during the vaccination session reported fewer doses administered compared to the monthly HF2 summary form. Health workers expressed that the EIR helped them to shorten the time to manage, summarize, and report vaccination records. Workflows for data entry in VaxTrac were inconsistent among facilities and rarely integrated into existing processes. Data sharing restrictions contributed to duplicate records. ConclusionAlthough VaxTrac helped to shorten the time to manage, summarize, and report vaccination records, data sharing restrictions coupled with inconsistent and inefficient workflows were major implementation challenges. Readiness-to-introduce and sustainability should be carefully considered before implementing an EIR.

Operational analysis of school-based delivery models to vaccinate children against influenza

ABSTRACT Large-scale immunisation programmes against seasonal influenza are characterised by logistical challenges related to the need for vaccinating large cohorts of people in a short amount of time. Careful operational planning of resources is essential for a successful implementation of such programmes. We focused on the process of child vaccination in schools and analysed the staffing and workflow aspects of a school-aged children vaccination programme in England. Our objectives were to document vaccination processes and analyse times and costs associated with different models deployed across England. We collected data through direct non-participatory observations. Statistical data analysis enabled us to identify potential factors influencing vaccine delivery time and informed the development of a tool to simulate vaccination sessions. Using this tool, we carried out scenario analyses and explored trade-offs between session times and costs in different settings. Our work ultimately supported the local implementation of school-based vaccination.

Clostridium tetani infection in pediatric intensive care unit of the CHU of Tamatave Madagascar

Justification: Tetanus, fatal disease, still exists in Madagascar in spite of the vaccination sessions of mass, and attacks also the children. Objective: To describe the epidemiology, the clinical aspect, the treatments and the evolutions of infantile tetanus. Patients and methods: Retrospective study in the pediatric intensive care unit of the University Hospital of Tamatave, on the cases listed during four years (2013-2016). Results: Twenty-seven cases were recensed, with an average age of 10.8 years old and a sex ratio (M/W) equal to 6. Only forty-one percent were already vaccinated before the one year age. No child of more than 11 years-old profited from vaccine recall. The stain of the wound after the ablation of flea was the most frequent cause (76%). Tetanus was generalized in 80%, including 44.4% with respiratory disorder having required intubation. All the children presented hyperthermia above 38°C at the entry and 63% higher or equal to 40°C. Sedation by diazepam, used at all children, was used with an average amount of 4 mg/kg/day. The beta-lactamine antibiotics were used in 100% of the cases. The antitetanus serum was administered at 3000 IU/day. Nosocomial infections occurred in 61%. The mean hospitalization duration was around 11 days. Mortality was 47%. Discussion and conclusion: The vaccine recalls are still negligent in the old children, making these latter vulnerable. Mortality is especially due to superinfections and denutrition.

Comparing vaccination hesitancy in Polish migrant parents who accept or refuse nasal flu vaccination for their children

This study investigates the background to low uptake of nasal influenza vaccination in Polish pupils in Edinburgh, Scotland. In autumn 2018, one week after their child's nasal flu vaccination sessions, 365 Polish parents were sent a questionnaire exploring influences on their vaccination choices. The questionnaire included a series of 10 vaccine hesitancy questions recommended by the WHO SAGE Working Group on Vaccine Hesitancy.128 questionnaires were returned representing 43.4% of vaccinated, 41.9% of refusing and 23.8% of non-consent form returning parents. Responses highlighted concerns about side effects, new vaccines and the accuracy of professional advice and information sources. There was complacency expressed about vaccination against diseases that are not common any more. Vaccine refusers were consistently more negative about all aspects vaccination and more likely to answer 'don't know'. Almost half of refusers were uncertain about the quality of health information offered to them.Polish migrants in Scotland come with their beliefs about vaccination and modify these as they acculturate to the UK system. They also continue to be influenced by developments and opinions, norms and values from their home country, as well as diaspora media. We have highlighted issues of concern among Polish migrants as a group and gained additional insights by comparing responses of parents who have refused or accepted vaccination. These insights can inform and target messages and strategies to build confidence and encourage immunisation, which should lead to improved vaccine uptake among ethnic population groups.

A new strategy to promote flu vaccination among health care workers: Molinette Hospital's experience

Seasonal flu represents a major public health issue, especially for health care workers (HCWs). WHO highlights the need of higher awareness and flu vaccine coverage among HCWs. In Europe the coverage is less than 30-40%. Italy reports some of the lowest rates. The paper aims to illustrate the 2017/2018 flu vaccination campaign within Molinette, the third Italian hospital for dimensions, to provide inputs about strategies for increasing HCWs coverage. The campaign objective was to increase the administered doses at least of 30%. The intervention included informational material, direct educational sessions for workers, extension of the access time to Occupational Medicine Service, elimination of the reservation requirement, composition of "moving vaccination units" (MVUs), and organisation of vaccination sessions within departments. In 2017/2018, 593 doses were administered. The doses percentage change between 2017/2018 and 2016/2017 vaccination seasons was +46.06%, while it was +84.74% compared with the previous 5-year period mean. The majority was administered by Occupational Medicine Service, while 6.75% by MVUs. Among the total doses, 72.68% were administered to workers, 13.49% to residents, 6.75% to students, and 7.08% to "other". So, 7.68% of total workforce was vaccinated. Only 0.3% of vaccinated people presented mild adverse reactions. A combined campaign, that includes actions for education, increase of awareness, improved access to facilities and active offers to workers has potentiality but there is still work to do. The vaccination increase was determined mostly by the re-organization of the occupational medicine, while the MVUs were useful to HCWs of detached offices.

Measles outbreak at the Val Thorens ski station, France, 2019

Abstract During the 2019 winter season, a measles outbreak occurred at the Val Thorens ski station in France, in an area frequented by over 300,000 holiday-makers (70% foreigners) and 2,500 seasonal workers. Between 24/01/2019 and 15/04/2019, 55 cases were reported (18 confirmed and 37 clinical). Apart from 5 infected children under 2 years old attending the same nursery, cases were mainly seasonal workers between 19 and 41 years old. Five cases were hospitalised, one with severe pneumonia. Of the 36 cases with known vaccination status, 25 (69%) had not completed 2-dose vaccination. Other confirmed cases in visitors to Val Thorens were reported in neighbouring valleys (n = 3), and in other French regions. One case was reported the French overseas territory Guadeloupe (WHO ‘Americas’ region where measles has been eradicated). British, Belgian, Danish, Dutch and Irish authorities reported 7 cases in people who had stayed in the area. The list of exported cases is non-exhaustive. The regional health agency (ARS) provided increased information on epidemic risk and vaccination recommendations, particularly to health professionals and the town council. Identifying all contacts was difficult because many had occurred with seasonal workers. In addition to the approximately 150 vaccinations carried out by the Val Thorens medical centre from the start of the outbreak, only 41 other people were vaccinated in 5 free vaccination sessions organized in situ by the ARS, and the local medical and immunization centres. The large attendance at the station favoured the outbreak and its extension in France and abroad. Due to low measles vaccine coverage in France (80.3% for 2-dose cover in 2 years in 2017), outbreaks in non-vaccinated and not fully vaccinated populations are increasing, as seen in Val Thorens. Key messages A major measles epidemic occurring in an undervaccinated population in frequent contact with tourists, led to the extension of cases in France and Europe. Despite 5 free in situ vaccination sessions, with the mobilisation of local health professionals, few seasonal workers came to be vaccinated.