Vaccination Coverage Research Articles

Preventive behaviors for COVID-19 in Chile: Lessons from a population follow-up for 2021 and 2022.

The rapid emergence of COVID-19 urged policy responses worldwide, focusing on vaccination and mobility restrictions. Chile represents a unique scenario for analyzing personal preventive measures amid intensive communication and vaccination campaigns. This study aims to explore changes in population adherence to non-pharmacological preventive measures during the pandemic and the factors that explain this adherence each year. 386 individuals who participated in two population-based studies (2021 and 2022) were considered. An interview was conducted to measure adherence to self-care practices, and case and contact tracing by the health authorities. The Wilcoxon signed-rank test was performed to measure change between 2021 and 2022, bivariate analysis, and a linear regression model for each year were performed. Mask-wearing in public places was the most commonly used measure (95.9% in 2021, 89.9% in 2022). Follow-up of cases and cases contacts by the health authority had high coverage in 2021 (94.3% and 83% respectively). A greater decrease was observed in contact tracing in 2022 totaling 33.3%. An increase in the score of adherence to preventive practices was observed in 2022 (p < 0.00). The regression model showed in 2021 that women were more likely to adopt preventive behaviors (95% confidence interval: 0.27 to 1.13) and the overweight/obese had higher adherence compared to normal body mass index (95% confidence interval: 0.06 to 0.98). In 2022 being a young adult (30 to 49 years) predicted the adoption of behavioral precautions (95% confidence interval: 0.00 to 1.32). Adherence to preventive measures increased even with high vaccination coverage, likely due to the epidemiological situation with the Omicron variant circulating in 2022.

A Survival Analysis of Rural-Urban Disparities in COVID-19 Vaccination Uptake in the United States.

Though urban-rural disparities in COVID-19 vaccination coverage was documented at a point of time, little is known on the evolution of vaccination uptake over time. This study, using individual level time-to-event data, intend to assess the differences in monthly progression of vaccination uptake among U.S. adults by urban/rural residence. Survival analysis. Urban and rural areas in 29 U.S. states. 135,969 adults aged 18+ years. Time (in months) to receive the first dose of COVID-19 vaccine since the U.S. Food and Drug Administration (FDA) Emergency Use Authorization of Pfizer-BioNTech- and Moderna- COVID-19 Vaccine in December 2020. Kaplan-Meier survivor functions and stratified Cox proportional hazard models were estimated for the event of being vaccinated by urban/rural residence for 25months starting from December 2020. Monthly survival probabilities for urban- and rural- adults were further assessed within certain demographic and socioeconomic groups. We found a gradual divergence of COVID-19 vaccination uptake in favor of urban adults, which was robust across sex, age groups, race and ethnicity, education, and income levels. In April 2021, after vaccine eligibility was expanded, 42.2% adults in urban and 53.3% adults in rural areas were unvaccinated. While only 19.3% urban adults remained unvaccinated in December 2022, this rate was 32.5% among rural adults. Compared to their urban counterparts, rural adults were 0.77 (95% CI: 0.76 - 0.79) times as likely to receive the first dose of COVID-19 vaccine. Time-to-event analysis of vaccination against COVID-19 indicated a lower uptake among rural adults, which was persistent across different demographic and socioeconomic groups.

Potential role of heterologous flavivirus immunity in preventing urban transmission of yellow fever virus

During the recent yellow fever (YF) epidemics in Brazil, human cases were attributed to spillover infections via sylvatic mosquito transmission. Despite YF virus (YFV) transmission in major urban centers with insufficient vaccination coverage and abundant populations of the domestic vector, Aedes aegypti, there was no evidence of human-amplified transmission. Furthermore, the historic absence of YF in Asia, despite abundant Ae. aegypti and an immunologically naive human population, is unexplained. We tested the hypothesis that pre-existing, heterologous flavivirus immunity, specifically from dengue (DENV) and Zika (ZIKV) viruses, limits YFV viremia and transmission by Ae. aegypti. We infected cynomolgus macaques with DENV or ZIKV, then challenged them 6–9 months later with YFV. We then measured viremia and disease and allowed Ae. aegypti mosquitoes to feed during peak macaque viremia. Although prior heterologous immunity had variable effects on disease, DENV and ZIKV immunity consistently suppressed YFV viremia. Despite no statistical difference due to a small sample size, the suppression in viremia led to a significant reduction in Ae. aegypti infection and a lack of transmission potential. These results support the hypothesis that, in DENV- and ZIKV-endemic regions such as South America and Asia, human flavivirus immunity suppresses YFV human amplification potential, reducing the risk of urban outbreaks.

Barriers and Strategies for Rotavirus and Cholera Vaccine Uptake: A Systematic Review of Community-based Interventions in Bangladesh, India, and Pakistan

Background: Diarrhea is the second leading cause of death in children and poses a major threat to public health. It is mainly caused by pathogenic organisms of viral, bacterial, or fungal origin, two of which has been preventable via vaccination and has been identified as rotavirus and cholera. In 2020, India, Pakistan, and Bangladesh were among the top 10 South Asian countries with the highest mortality rates from childhood diarrhea. India and Pakistan are further listed by the WHO among the top five countries with the highest recorded mortality among children under five years old. Bangladesh has experienced the highest number of cholera epidemics. Vaccination is recommended as a potent preventive approach against rotavirus and cholera induced diarrhea and is considered the most cost-effective prevention method. However, despite their proven effectiveness, other factors appear to affect the impact of vaccination strategies in these countries. Therefore, this study aimed to explore these nonclinical factors. Methods: This study was conducted as a systematic review which involved the systematic search and selection of qualitative data from primary studies concerning the research topic which was developed using the SPIDER framework. The PRISMA tool was used to carry out this process, and the CASP was used to evaluate the methodological quality of each study. The combined data were then harmonized using meta-synthesis and analyzed thematically. Findings: Four themes emerged from the analysis of the study data: pre-vaccination strategy experience, post-vaccination strategy impact, opportunities for vaccination strategies, and threats to successful implementation of vaccination strategies. This formed the basis of the study discussion and expounded on the impact of vaccine strategies in the selected countries. Conclusion: The results of this study showed that providing the participants with correct information, vaccine education, willingness to learn despite poor knowledge, and access to vaccination are important solutions to the factors that surround the uptake and coverage of cholera and rotavirus vaccines in Bangladesh, India, and Pakistan as critical influencers of the prevalence of childhood diarrhea induced by rotavirus and cholera pathogens, respectively.

The impact of COVID-19 on private healthcare service utilisation: time series analysis in the capital region of Finland during 2020–2022

BackgroundMost current studies on COVID-19 have focused on the first weeks or months of the pandemic or have addressed specific diseases. The long-term effects of the COVID-19 pandemic on healthcare services are insufficiently understood. We analysed the long-term effects of the COVID-19 pandemic on outpatient healthcare utilisation in the full spectrum of diseases in Uusimaa, the capital region of Finland.MethodsOur data included 632 466 individual patients between the ages of 18 and 65 and 6 521 394 visits to healthcare personnel from electronic health records. We fitted an autoregressive integrated moving average (ARIMA) model to pre-2020 data to predict the expected quantity of diagnoses for the period between 1 January 2020 and 16 June 2022. Expected and observed quantities of diagnoses were compared.ResultsThe overall quantity of diagnoses declined by one-fourth immediately following the onset of the pandemic and remained around 15% below predicted values for most of the pandemic. After the pandemic-related restrictions were lifted, the total diagnostic activity started to recover to pre-pandemic projection levels. However, this recovery has been mainly driven by upper respiratory system-related activity. The number of diagnoses for many diagnosis groups has remained below the predicted levels, even after the concurrent removal of mobility restrictions and increased coverage of vaccinations in this population.ConclusionsThe pandemic resulted in an overall reduction in outpatient healthcare utilisation which persisted for 30 months. While the overall diagnostic activity has eventually recovered to predicted levels, many classes of diagnoses display reduced levels in the study population over the follow-up period. Some diseases that may have long-lasting effects when left untreated seem to remain underdiagnosed, potentially increasing pressure on the healthcare system in the future.

Knowledge, Attitudes, and Practices Regarding Influenza Vaccination Among Healthcare Workers in Saudi Arabia: A Cross-sectional Study.

Influenza vaccination is important for healthcare workers in order to prevent both the illness itself and transmission to patients. Previous studies in Saudi Arabia have revealed low influenza vaccine coverage among healthcare workers due to misconceptions. This study aimed to assess knowledge, attitudes, and practices regarding influenza vaccination among healthcare workers during 2021, addressing the current data gap. A cross-sectional study was conducted, including 1,273 healthcare workers from the Ministry of Health in Saudi Arabia. A self-administered questionnaire was distributed to participants via email. Statistical analysis was conducted using Jamovi software (version 2.3). Ethical approval was obtained from the Ministry of Health Ethics Committee. Most participants had an appropriate extent of knowledge, with 37.1% having a high level and 26.6% having a moderate level. Positive attitudes toward the influenza vaccine were observed in 41.2% of participants, and 80.2% demonstrated good vaccine practices. However, the vaccine coverage was 51% in the past 12 months. Factors associated with vaccine uptake included previous vaccination, workplace availability, awareness of guidelines, engagement in training programs, type of workplace settings, and having positive attitudes toward the vaccine. The most common reason for not getting vaccinated was the perception of being at low risk, making vaccination unnecessary. Participants exhibited positive knowledge, attitudes, and practices regarding influenza vaccination. However, the observed vaccine uptake rate fell below the recommended coverage rate, indicating the presence of a knowledge-behavior gap. Targeted interventions are recommended to improve vaccination uptake among healthcare workers in Saudi Arabia.

ATTITUDES AND AWARENESS OF THE POPULATION OF CENTRAL AND WESTERN REGIONS OF UKRAINE TOWARDS VACCINATION

In the modern world, vaccination is the most eff ective and evidence- based method of preventing the onset and severity of infectious diseases. Today, the WHO has identifi ed vaccine hesitancy as a global public health threat [25]. The social and cultural background of people infl uences their perception of vaccines, which prompted us to investigate this problem. Aim. To study the infl uence of sociodemographic factors on vaccination attitudes of children and adults in the central and western regions of Ukraine.Materials and methods. A cross- sectional study was conducted, which included a survey of the population of diff erent social status. The study was conducted in accordance with the tenets of the Declaration of Helsinki. The study protocol was approved by the bioethics committee. We also analyzed literature data from PubMed, Medscape and CSC. The work was performed within the framework of the research project 0122U000039 «Improvement of methods of diagnosis, treatment and rehabilitation of the most common diseases of childhood». No confl icts of interest exist.Research results and discussion. 1000 respondents were interviewed by questionnaire from Kyiv, Cherkasy, Kirovograd, Khmelnytsky, Zhytomyr, Chernivtsi, Ternopil, Rivne, Volyn, Ivano- Frankivsk, Lviv regions. The data obtained indicate that barriers to vaccination are caused by low awareness of vaccination, excessive negative infl uence of opinion leaders, prevalence of myths and falsifi cations about vaccination, lack of health care resources and low supply of recommended vaccines, and forced migration. Low awareness and low vaccination coverage are also associated with low awareness among health workers who do not work directly with vaccines, falsifi cation of vaccination data, and the presence of anti-vaccine health workers. The negative attitude of parents towards vaccination is also very important, as it aff ects their children.Conclusions.1. Fear of side eff ects, long-term complications, and doubts about the quality of vaccines have been identifi ed as factors in vaccine refusal.2. The most common groups of vaccine refusers are the elderly (53.3 %) and men (16.8 %).3. The high cost of vaccines that are not included in the list of mandatory vaccines is one of the reasons for the decrease in vaccination rates.4. Improved communication between the doctor and the patient is one of the factors increasing the vaccination rate among the population.5. Information about the availability of vaccines and places of vaccination, peculiarities of the post-vaccination period and information about the possible consequences of ignoring vaccination should be provided in the media (television, radio), especially among the elderly.

Self-reported hepatitis A and B vaccination coverage among men who have sex with men (MSM), associated factors and vaccination recommendations in 43 countries of the WHO European Region: results from the European MSM Internet Survey, EMIS-2017.

BackgroundHepatitis A and B vaccinations are recommended for men who have sex with men (MSM), given their increased risk of infection. However, data on vaccination programmes are scarce.AimTo use information on vaccination recommendations and vaccine uptake among MSM in the WHO European Region to guide prevention.MethodsFrom a large pan-European MSM Internet Survey (EMIS-2017), we analysed data on self-reported hepatitis A and B vaccination status by age, education, financial coping, settlement size, outness (disclosure of sexual behaviour), migration history and diagnosis with hepatitis C or HIV, using multivariable logistic regression. Additionally, we collected information on national hepatitis A and B vaccination recommendations.ResultsWe present data of 113,884 MSM, median age 36 years (IQR: 27-47). Vaccination for hepatitis A and B was recommended and free for MSM in 7 and 18 of 43 countries, respectively. Of all respondents, 48% (n = 50,966) reported ever being vaccinated against hepatitis A, and 53% (n = 56,889) against hepatitis B. Odds for being vaccinated against hepatitis A increased with outness ('out to (almost) all' aOR: 1.78, 95% CI: 1.72-1.85 vs 'out to none') and were higher in countries where vaccination was recommended and free for MSM (aOR: 2.22, 95% CI: 1.29-3.82 vs 'no recommendation'). Results for hepatitis B were similar (outness: aOR: 1.81, 95% CI: 1.75-1.88 and MSM-specific vaccination recommendation: aOR: 2.44, 95% CI: 1.54-3.85).ConclusionLarge proportions of MSM in Europe remain vulnerable to hepatitis A and B, despite available vaccination. Implementation of MSM-specific vaccination recommendations and greater efforts to improve the societal climate for MSM are needed to address gaps in vaccine coverage.

Exploring determinants of basic childhood vaccination coverage in Bangladesh: a generalized Poisson regression analysis

IntroductionChildhood vaccination is crucial for safeguarding children against potentially life-threatening diseases. This study aims to investigate the significant factors influencing vaccination coverage among children aged 12–59 months in Bangladesh.MethodsThe study utilizes cross-sectional data from the 2017–18 Bangladesh Demographic and Health Survey. A Kruskal–Wallis test is employed in bivariate analysis to identify significant predictors associated with childhood immunizations. A generalized Poisson regression model is applied to assess the impact of various risk factors on children’s incomplete vaccination status.ResultsChildren born in the Sylhet division show lower chances of receiving immunizations. Additionally, children whose mothers are younger, have no education or only primary education, and are unemployed, are less likely to be fully vaccinated. Furthermore, children born into smaller families, first birth, those whose mothers had access to media, and those who received more than four antenatal visits during pregnancy are more likely to have received all recommended vaccines.ConclusionImplementing targeted interventions to improve childhood vaccination coverage, particularly among vulnerable populations such as young and uneducated mothers with middle-income status, is crucial. Enhancing media access, promoting the utilization of antenatal care at health care facilities, and raising awareness about the benefits of vaccination can help ensure optimal vaccination coverage among children in Bangladesh.

Variations in COVID-19 vaccine hesitancy over time: a serial cross-sectional study in five West African countries

ObjectivesThis study aims to identify the factors influencing vaccine hesitancy, willingness and its variation over time in order to inform more responsive strategies for increasing vaccination uptake. The specific objectives...

Routine HPV vaccination: Reflection on delivery strategies based on countries’ experiences

Despite the introduction of the human papillomavirus (HPV) vaccine in many low- and middle-income countries (LMICs), countries are still struggling to maintain HPV vaccination coverage and manage sustainable delivery strategies. This article explores the challenges and effective strategies for HPV vaccine delivery in LMICs, with a focus on reflecting upon current HPV vaccine delivery strategies in the World Health Organization (WHO) HPV vaccine introduction guidelines to align with practical implementation experiences. The article utilizes presentations and discussions from Coalition to Strengthen the HPV Immunization Community (CHIC) symposia, field experiences of program implementers who participated in the meeting and immunization expert opinions, to inform its findings. Several countries are spotlighted for their delivery strategies. These include routinized campaign mode vaccinations at schools in The Gambia, Zambia, and Ethiopia; routine health facility services in Tanzania, Kenya, and Maldives; and outreach strategies targeting out-of-school girls. By evaluating these diverse strategies, the article suggests a need to delve deeper and build an understanding of the routinized campaign mode of HPV vaccine delivery, and advocates for expanding the scope of delivery strategies and consequently updating the WHO HPV vaccine delivery guidelines in line with the evolving landscape of HPV vaccination delivery to ensure comprehensive, cost-effective, and sustainable programs in LMICs.

Identifying key challenges and optimizing approaches for training of health care professionals for HPV vaccination programmes

Healthcare professionals (HCPs) play a crucial role in building vaccine confidence and promoting vaccination programmes. HCP vaccination recommendations are often the strongest predictor of vaccine uptake, influencing individuals' acceptance of and demand for vaccination. However, HCP training on human papillomavirus (HPV) vaccination faces challenges in some countries, including Ethiopia, Malawi, and Uganda. This study summarizes the discussions held during the Coalition to Strengthen HPV Immunization Community Symposium in Africa, the field experiences of co-authors, and expert opinions to inform its findings. Key challenges faced in these countries are maintaining regular and comprehensive HCP training, ensuring continuity due to staff turnover, reaching all health facilities, and including teachers as key mobilizers. Funding constraints, limited communication materials, and human resource shortages can further impact training effectiveness. Recommendations for strengthening HCP training on HPV vaccination programmes include providing adequate training to all HCPs, refresher training, including private sector HCPs and teachers, leveraging local training institutions, and integrating HPV vaccine training into pre-service HCP academic curricula. These actions would be essential for improving HPV vaccine coverage and working towards cervical cancer elimination goals.

Status of HPV disease and vaccination programmes in LMICs: Introduction to special issue

Sexually transmitted human papillomavirus (HPV) infections are extremely common in both men and women and while most will clear naturally, some may progress to cervical cancer and other cancers. Despite the availability of prophylactic vaccines and well-established screening and treatment practices, the global burden of HPV-related disease remains high, particularly in low-and-middle-income countries (LMICs). We outline the current global epidemiology of cervical cancer disease incidence and mortality, with the highest burden in Africa and Asia. As part of a strategy to eliminate cervical cancer as a public health problem, the WHO recommends a 3-fold approach combining the use of prophylactic vaccines with cervical cancer screening and treatment. This overview focuses on the globally available HPV vaccines and current status of vaccine introduction in LMICs. We describe decreased HPV vaccination coverage in recent years and highlight the need for emphasis on new vaccine introductions and existing vaccine programme strengthening in order to reach goals for the elimination of cervical cancer as a public health problem. It is estimated that US$3.20 will be returned on each dollar invested in cervical cancer prevention efforts through 2050 [1]. Success for these initiatives centers on strategic vaccine delivery and collaborations that foster political support and engagement with civil society organisations and educational sector stakeholders. Recent increases in vaccine supply and single-dose efficacy evidence pave the way for cervical cancer elimination through vaccination coupled with screening and treatment. Subsequent manuscripts in this supplement will outline case studies and lessons from two symposia held in Africa and South Asia by the Coalition to Strengthen the HPV Immunization Community in 2022 including evidence for a one-dose strategy, the challenges of maintaining vaccine programmes during the COVID-19 pandemic, and progress in cervical cancer screening programmes.

Influenza Vaccination Coverage and Influencing Factors in Type 2 Diabetes in Mainland China: A Systematic Review and Meta-Analysis

Background: Influenza has many harmful effects on people with type 2 diabetes mellitus (T2DM), such as hyperglycemia and increasing incidence of cardiovascular and cerebrovascular diseases. Epidemiological evidence shows that influenza vaccinations can effectively prevent deterioration in T2DM patients. At present, there is a lack of nationwide studies on the vaccination status of influenza vaccines for patients with certain chronic diseases. This study aimed to evaluate the influenza vaccination status of T2DM patients in mainland China and the factors affecting their influenza vaccination. Methods: Data were sourced from PubMed, Embase, Web of Science, the China Biology Medicine Disc (CBMdisc), the China National Knowledge Infrastructure (CNKI), and the Wanfang Database. The keywords used in the literature search included “diabetes”, “diabetes mellitus”, “DM”, “diabetic”, “T2DM”, “influenza vaccine”, “flu vaccine”, “China”, and “Chinese”. A total of 249 articles were retrieved through the searches; 7 articles met the inclusion criteria. The fixed-effects model was used when heterogeneity was low and a random-effects model was used when the heterogeneity was high. Results: The influenza vaccination coverage rate was 1.46% in diabetic patients and 9.99% in elderly diabetic patients. The influenza vaccination rate of type 2 diabetes patients with a high education level is higher than that of patients with a low education level. (OR: 1.462 [1.123, 1.903]). Meanwhile, gender (OR: 1.076, 95%CI: 0.893–1.295), marriage (OR: 1.283; 95%CI: 0.931–1.766), and occupation (OR: 1.049; 95% CI: 4.422–2.606) have no significant impact on influenza vaccination in patients with type 2 diabetes. Conclusions: This study found that the coverage of influenza vaccination in patients with T2DM in Chinese mainland was low, and there were few relevant research articles. In China’s mainland areas, education background is an important factor affecting the influenza vaccination of T2DM patients. China should continue to improve the influenza vaccination rate of patients with type 2 diabetes.

Measles–Rubella Microarray Patches Phase III Clinical Trial Framework: Proposal and Considerations

Background: The Measles–Rubella Microarray Patch (MR-MAP) is an important technology that is expected to reduce coverage and equity gaps for measles-containing vaccines (MCVs), reach zero-dose children, and contribute to elimination of measles and rubella. MR-MAPs are anticipated to be easier to deploy programmatically and could be delivered by lesser-trained health workers, thereby increasing immunization coverage. The most advanced MR-MAP has reached clinical proof-of-concept through a Phase I/II trial in the target population of infants and young children. The World Health Organization (WHO) and partners have developed the Phase III clinical trial framework for MR-MAPs presented in this article. Objectives and Methods: The purpose of such framework is to inform the considerations, design and approach for the pivotal clinical trial design, while considering the anticipated data requirements to inform regulatory approval, WHO prequalification, and policy decision. Results: The proposed Phase III trial would compare the immunogenicity and safety of an MR-MAP with MR vaccine delivered subcutaneously in 9- to 10-month-old infants. An analysis of non-inferiority (NI) of immunogenicity would occur six weeks after the first dose. Should regulatory agencies or policy makers require, a proportion of infants could receive a second dose of either the same or alternate MR vaccine presentation six months after the first dose, with those children returning six weeks after the second dose for a descriptive assessment of immunogenicity, and then followed up six months after the second dose for evaluation of safety and immunogenicity. It is anticipated that this proposed pivotal Phase III trial framework would generate the required clinical data for regulatory licensure and WHO prequalification (PQ) of MR-MAPs. However, the trial design would need to be reviewed and confirmed by a national regulatory authority (NRA) that will assess the product for regulatory licensure and the WHO PQ team. Additional research will likely be required to generate data on concomitant vaccine delivery, the safety and immunogenicity of MR-MAPs in other age groups such as children 1–5 years and infants younger than 9 months of age, and the impact of MR-MAPs on coverage and equity. Such studies could be conducted during or after clinical MR-MAP development.

Trend of immunization &amp; gap in vaccine doses as observed in National Family Health Survey rounds in India

Background &amp; objectives Immunization is an efficient and cost-effective way of lowering the infectious disease related morbidity and mortality in the community. The current study reviewed the trend of immunization, gaps in doses of vaccine given at the same time and gaps between the doses of same vaccine from National Family Health Survey (NFHS 1-5) rounds. Methods The current study extracted data from all five NFHS rounds conducted from 1992-93 to 2019-21. The study analyzed the State-wise and demography-wise distribution of trends of immunization from NFHS-1 to NFHS-5. State wise distribution of change in vaccination coverage between NFHS-4 and 5 was analyzed. The study also assessed the State-wise trends of fully vaccinated and unvaccinated children from NFHS 1-5. Results The northeastern States had maximum gap between the vaccination given at birth i.e., 47.3 per cent between BCG and Hepatitis B, and 32.8 per cent between BCG and birth dose of OPV in Manipur in NFHS -5. A gradual rise in the percentage of male (40.2%) and female (41.9%) childrens’ vaccination was found across the NFHS rounds with reduction in gap between the male and female vaccination from NFHS-1 (2.6%) to NFHS-5 (0.9%). The percentage of vaccination decreased proportionately with birth order. The vaccination coverage has increased in both urban and rural population, but the rise was higher in rural (45.9%) areas than urban (24.8%). An increase in percentage of fully vaccinated children by 41.2 per cent and decrease in percentage of non-vaccinated children by 26.4 per cent was observed from NFHS-1 to NFHS-5. Interpretation &amp; conclusions Our analysis clearly suggests that immunization coverage has improved over a period of time but the variability in vaccine coverage across States and gap in vaccine doses needs attention of the policy makers to cover this for achieving our national immunization goals.

Measles surveillance data analysis and serological survey in Quzhou, China, 2014–2024: an assessment of progress toward measles elimination

BackgroundMeasles is a disease that can be eliminated through vaccination. In recent years, measles incidence and mortality have been greatly reduced.MethodsAnalyze measles surveillance data from 2014 to 2023 and measles seroepidemiological characteristics of healthy populations in 2024 to assess progress toward measles elimination.ResultsA total of 35 measles cases were reported in the surveillance system from 2014–2023 in Quzhou, with an average annual incidence of 1.6/1 million. Since 2019, the incidence of measles has been lower than 0.5/1 million. A serological survey of 257 healthy people showed that the positive rate of measles IgG antibody was 90.3%, and the immunity of all age groups except 0–5 years old was lower than 95%, which did not reach the threshold of 95% herd immunity required for eliminating measles.ConclusionAlthough the incidence of measles in Quzhou is low, the immunity of healthy people to measles infection is insufficient. Measles is still in the control phase, not in the elimination phase. Inadequate immunity in the population may be due to the failure to achieve ≥95% vaccination coverage and low immunogenicity of the vaccine. Recommends that the quality of routine immunization data be assessed and monitored to verify reported vaccination coverage; at the same time, improve vaccination services and optimize vaccination policies to increase actual vaccination coverage. In addition, it is recommended to adjust the MMR immunization strategy, changing the time of the first MMR vaccination from 8 months of age to 12–15 months of age, and the second dose at 4 to 6 years of age.

Vaccine equity implementation: exploring factors influencing COVID-19 vaccine delivery in the Philippines from an equity lens

BackgroundDuring the early phase of the COVID-19 vaccine rollout, low and middle-income countries (LMICs) were facing challenges in achieving equitable vaccine delivery. Few studies have contextualized global vaccine distributive injustice into national-specific contexts to understand its impact on vaccine delivery from an equity perspective. We aimed to investigate factors influencing equitable COVID-19 vaccine delivery in the Philippines and to provide recommendations to enhance equitable vaccine delivery in LMICs to prepare for future health emergencies.MethodsThe Health Equity Implementation Framework was employed to guide this qualitative study. We recruited participants using purposeful and snowballing sampling strategies. Semi-structured interviews were conducted with participants in person, online, or over the phone. A reflective thematic analysis approach was employed to analyze data.ResultsWe recruited 38 participants including seven high-level stakeholders from the public and private sectors, 14 health workers, and 17 community members in the province of Negros Occidental, Philippines. Equitable delivery of COVID-19 vaccines was influenced by an interplay of multiple factors operating in different domains. Contextually, the rapidly evolving nature of the COVID-19 virus, ongoing scientific advancements, and international negotiations directed national-level vaccine policies. Political commitment and support were recognized as crucial drivers for successful vaccine delivery, with a strong emphasis on health information framing and communication and adherence to human rights principles. The vulnerability of the health system significantly impacted the timely and effective distribution of vaccines. Furthermore, the geographical characteristics of the Philippines presented unique logistical challenges to vaccine delivery. At the recipient domain, individual perceptions of vaccines, shaped by their socioeconomic status, exposure to (mis)information, social influence, and entrenched religious beliefs, played a major role in their vaccine decisions and thus vaccine coverage regionally. Additionally, vaccine characteristics and operational challenges related to its distribution also impacted fair allocation.ConclusionsThe findings highlight the urgent need for LMICs to strengthen their health system resilience and sustainability and use multilevel strategies to build public trust to improve vaccine uptake and coverage. Moreover, each LMIC must be attentive to its unique contextual factors to develop tailored implementation strategies to promote equitable vaccine distribution.

Recovery time and its predictors of severe acute malnutrition among under five children admitted at the therapeutic feeding center of Hiwot Fana comprehensive specialized hospital, eastern Ethiopia, 2024: a semi-parametric model

BackgroundEarly recovery is a performance indicator of quality care for children under five admitted due to severe acute malnutrition (SAM) at therapeutic feeding centers. Despite the available interventions to tackle such nutritional problems, there is limited information on the time to recovery and its predictors among children with severe acute malnutrition in Ethiopia, more particularly in the study setting.ObjectiveThe study aimed to assess the time to recovery from severe acute malnutrition and its predictors among children aged 6–59 months admitted to the therapeutic feeding center (TFC) of Hiwot Fana Comprehensive Specialized Hospital (HFCSH), eastern Ethiopia, from 1st September 2019 to 1st March 012024.MethodsA retrospective cohort study was conducted at the therapeutic feeding center of HFCSH among a randomly selected sample of 349 patients with severe acute malnutrition who were undergoing therapeutic feeding. Data were collected using a data abstraction tool and then stored in Epi-data version 4.6 and STATA version 17.0 statistical software. Descriptive statistics, Kaplan–Meier (KM) plots, median survival times, the log-rank test, and the Cox proportional hazards regression model were used to report the findings of this study. After performing the Cox proportional hazards regression, the model goodness of fit and assumptions were checked. Finally, the association between independent variables and the time to recovery in days was assessed using the multivariable Cox proportional hazards model, and the variables with a p-value &amp;lt;0.05 were considered statistically significant.ResultsThe median survival time to recovery among the patients with severe acute malnutrition was 17 days [95% confidence interval (CI): 16–18]. The incidence density recovery rate was 5.7 (95%CI, 4.9–6.6) per 100 person-days of observation. Factors that affected the time to recovery included residing in rural areas [adjusted hazard ratio (AHR) = 2.072; 95%CI = 1.336–3.215], being vaccinated according to age (AHR = 1.848; 95%CI = 1.162–2.939), and lack of analgesic administration (AHR = 0.685; 95%CI = 0.472–0.995).ConclusionThe median survival time to recovery in this study was found to be optimal. Residency, vaccination status of the child, and analgesic administration were the determinant factors. Paying attention to vaccination coverage, fever management, and pain management as part of the protocol helps reduce the length of hospital stay by facilitating recovery rates among severely malnourished children under five in Ethiopia.

Adapting COVID-19 research infrastructure to capture influenza and respiratory syncytial virus alongside SARS-CoV-2 in UK healthcare workers winter 2022/23 and beyond: protocol for a pragmatic sub-study

Introduction During the COVID-19 pandemic, extensive research was conducted on SARS-CoV-2; however, important questions about other respiratory pathogens remain unanswered. A severe influenza season in 2022–2023 with simultaneous circulation of SARS-CoV2 and respiratory syncytial virus is anticipated. This sub-study aims to determine the incidence and impact of these respiratory viruses on healthcare workers, the symptoms they experienced, the effectiveness of both COVID-19 and influenza vaccination and the burden of these infections on the National Health Service (NHS) workforce. Methods and analysis This is a longitudinal prospective cohort sub-study, utilising the population and infrastructure of the SARS-CoV-2 Immunity &amp; Reinfection Evaluation (SIREN) study, which focuses on hospital staff in the UK. Participants undergo fortnightly nucleic acid amplification testing on a multiplex assay including SARS-CoV-2, influenza A and B and RSV, regardless of symptoms. Questionnaires are completed every two weeks, capturing symptoms, sick days, exposures, and vaccination records. Serum samples are collected monthly or quarterly from participants associated with a SIREN site. This sub-study commenced on 28/11/22 to align with the predicted influenza season and participants’ influenza vaccine status. The SIREN Participant Involvement Panel shaped the aims and methods for the study, highlighting its acceptability. UK devolved administrations were supported to develop local protocols. Analysis plans include incidence of asymptomatic and symptomatic infection, comparisons of vaccination coverage, assessment of sick day burden, and effectiveness of seasonal influenza against infection and time off work. Data are also integrated into UKHSA nosocomial modelling. Ethics and dissemination The protocol was approved by the Berkshire Research Ethics Committee (IRAS ID 284460, REC Reference 20SC0230) on 14/11/2022. Participants were informed in advance. As the frequency and method of sampling remained the same, implied consent processes were approved by the committee. Participants returning to the study give informed consent. Regular reports to advisory groups and peer-reviewed publications are planned to disseminate findings and inform decision making. Clinical trial registration number: ISRCTN11041050; registration date: 12 January 2021. Sub study included in protocol version: v8.0, and amended in v9.0