Role of the nurse immuniser in implementing and maintaining the National Human Papillomavirus 'Cervical Cancer' Vaccine rollout through a school-based program in Victoria

In an effort to understand the strengths and limitations of current approaches to human papillomavirus vaccine (HPV) delivery in schools, we conducted an audit of nurse immunisers (NI). In this survey of 159 Victorian NI, the NI perceived that knowledge, safety and side effects were among the most important issues raised by parents, schoolgirls, and teachers in the school setting. The most common concern identified by NIs was the physical layout of the vaccination setting (41%), followed by safety, then knowledge of the vaccine. There is a need for ongoing assessment of factors that improve or impede the delivery of HPV vaccines.

Strategies for implementing school-located influenza vaccination of children: a systematic literature review

BACKGROUND

The Advisory Committee on Immunization Practices (ACIP) recommends influenza vaccinations for all children 6 months to 18 years of age, which includes school-aged children. Influenza immunization programs may benefit schools by reducing absenteeism.

METHODS

A systematic literature review of PubMed, PsychLit, and Dissertation Abstracts available as of January 7, 2008, was conducted for school-located vaccinations, using search words "School Health Services" and "Immunization Programs"; limited to "Child" (6-12 years) and "Adolescent" (13-18 years) for PubMed and "mass or universal" and (immuniz(*) or immunis(*) or vaccin(*)) and (school or Child or Adolescen(*)) for PsychLit and Dissertation Abstracts. Fifty-nine studies met the criteria for review.

RESULTS

Strategies such as incentives, education, the design of the consent form, and follow-up can increase parental consent and number of returned forms. Minimizing out-of-pocket cost, offering both the intramuscular (shot) and intranasal (nasal spray) vaccination, and using reminders can increase vaccination coverage among those whose parents consented. Finally, organization, communication, and planning can minimize the logistical challenges.

CONCLUSIONS

Schools-based vaccination programs are a promising option for achieving the expanded ACIP recommendation; school-located vaccination programs are feasible and effective. Adhering to lessons from the peer-reviewed scientific literature may help public health officials and schools implement the expanded recommendation to provide the greatest benefit for the lowest cost. Given the potential benefits of the expanded recommendation, both directly to the vaccinated children and indirectly to the community, prospective, well-controlled trials to establish the cost-effectiveness of specific vaccination strategies should be high priorities for future research.

The feasibility of canine rabies elimination in Africa: dispelling doubts with data

BACKGROUND

Canine rabies causes many thousands of human deaths every year in Africa, and continues to increase throughout much of the continent.

METHODOLOGY/PRINCIPAL FINDINGS

This paper identifies four common reasons given for the lack of effective canine rabies control in Africa: (a) a low priority given for disease control as a result of lack of awareness of the rabies burden; (b) epidemiological constraints such as uncertainties about the required levels of vaccination coverage and the possibility of sustained cycles of infection in wildlife; (c) operational constraints including accessibility of dogs for vaccination and insufficient knowledge of dog population sizes for planning of vaccination campaigns; and (d) limited resources for implementation of rabies surveillance and control. We address each of these issues in turn, presenting data from field studies and modelling approaches used in Tanzania, including burden of disease evaluations, detailed epidemiological studies, operational data from vaccination campaigns in different demographic and ecological settings, and economic analyses of the cost-effectiveness of dog vaccination for human rabies prevention.

CONCLUSIONS/SIGNIFICANCE

We conclude that there are no insurmountable problems to canine rabies control in most of Africa; that elimination of canine rabies is epidemiologically and practically feasible through mass vaccination of domestic dogs; and that domestic dog vaccination provides a cost-effective approach to the prevention and elimination of human rabies deaths.

Timing of children's vaccinations in 45 low-income and middle-income countries: an analysis of survey data

BACKGROUND

Vaccinations are often delayed until well after the recommended ages, leaving many children exposed for longer than they should be. We estimated vaccination coverage at different ages, and delays in administration, in 45 low-income and middle-income countries.

METHODS

We used data for 217 706 children from Demographic and Health Surveys between 1996 and 2005 (median 2002), which provided data for vaccination of children on the basis of events recorded on vaccination cards and interviews with mothers, with imputation of missing values and survival analysis. We devised an index combining coverage and delay.

FINDINGS

For vaccinated children, the median of the median delays in the 45 countries was 2.3 weeks (IQR 1.4-4.6) for bacille Calmette-Guérin (BCG); 2.4 weeks (1.2-3.3) for diphtheria, tetanus, and pertussis (DTP1); 2.7 weeks (1.7-3.1) for measles-containing vaccine (MCV1); and 6.2 weeks (3.5-8.5) for DTP3. However, in the 12 countries with the longest delays for each vaccination, at least 25% of the children vaccinated were more than 10 weeks late for BCG, 8 weeks for DTP1, 11 weeks for MCV1, and 19 weeks for DTP3. Variation within countries was substantial: the median of the IQRs in the 45 countries for delay in DTP3 was 10.9 weeks, 7.9 weeks for MCV1, 5.4 weeks for BCG, and 5.3 weeks for DTP1. The median of the national coverage rates for DTP1 increased from 57% in children aged 12 weeks to 88% at 12 months, and for DTP3 from 65% at 12 months to 76% at 3 years.

INTERPRETATION

The timeliness of children's vaccination varies widely between and particularly within countries, and published yearly estimates of national coverage do not capture these variations. Delayed vaccination could have important implications for the effect of new and established vaccines on the burden of disease.

FUNDING

WHO's Initiative for Vaccine Research.

Immune response to measles vaccine after mass vaccination in Urmia, Islamic Republic of Iran

We investigated the effectiveness of the mass measles vaccination campaign in Urmia, Islamic Republic of Iran, by examining the measles IgG seroprevalence and antibody response from paired data before and after the campaign. The overall seropositive rate of 624 subjects aged 5-25 years increased 1 year after the mass vaccination (from 53.0% to 72.3%). A rise in antibody titre occurred in all age groups except the 21-25 years group, which had the highest titre before mass vaccination. On logistic regression analysis, only immune status prior to vaccination was significantly associated with the seroresponse. It may be cost-effective to check antibody titres before mass vaccinations, especially in high vaccine coverage regions with circulating wild virus.

Health care provider attitudes and practices regarding adolescent immunizations: a qualitative study

OBJECTIVE

Assess health care providers' attitudes and practices regarding adolescent immunizations, including factors that either impede or facilitate vaccination.

METHODS

Focus groups-In 2005, 3 focus groups were conducted in Monroe County, NY for (1) urban primary care physicians (PCPs); (2) suburban PCPs; and (3) nurses from practices represented in PCP groups. Audiotaped discussions were transcribed and analyzed using Atlas.ti. Key informant interviews-We recruited knowledgeable informants (18 physicians, 6 nurses) from across the US. The authors conducted in-depth telephone interviews with the participants, typed their interview notes, and sent them to the participant for verification. Separately for nurses, urban physicians, and suburban physicians results for each question were listed and reviewed by the authors. Themes were added to those from the focus groups.

RESULTS

Three overarching themes were identified: professional buy-in (e.g., reimbursement, professional organization recommendations, disease and vaccine characteristics, office consensus); parent/adolescent buy-in (e.g., school requirements, perception of MD recommendations, cost and insurance coverage, media reports, disease and vaccine characteristics, "vaccine fatigue"), and delivery factors (e.g., vaccine supply, ordering, timing and scheduling, consent).

CONCLUSIONS

Providers identified intertwined system issues that color their attitudes about adolescent immunization.

PRACTICE IMPLICATIONS

Buy-in and delivery factors must be addressed before high immunization rates will be achieved.

Introduction of human papillomavirus (HPV) vaccination in Sweden

The Swedish National Board of Health and Welfare (NBH) decided that a vaccine that protects against cervical cancer caused by human papillomavirus (HPV) should be included in the childhood vaccination directive as a nationwide-programme targeting 12-year-old girls from 2010 as a part of the school-health programme. Currently, vaccination of girls 13-18 years of age is covered by the public insurance. In this paper we describe the decision-making process behind the introduction of HPV vaccination in Sweden.

Evaluation of intensive pulse polio immunisation in south Gujarat region of India

Randomly selected team members of 50% booths in urban areas of Surat, Valsad and Bharuch districts and 25% in tribal areas of Narmada and Dangs districts of South Gujarat region were Interviewed to evaluate the pulse polio immunisation coverage in urban and tribal areas of South Gujarat region. Evaluation of two consecutive rounds of pulse polio immunisation had shown that the booth coverage is about 90% and 80% in urban and tribal areas respectively. Television was the main source of information for pulse polio round in urban areas, while anganwadi workers were in tribal areas. During house to house activity, few unimmunised children were found. X to P conversion was found almost nil at the end of day in both the rounds. The present study shows the deficits in programme implementation even after many years of campaigning and provides extents to which strengthening Is needed especially in urban area.

Agent-based modeling for real-time decision-support for point-of-distribution managers during influenza mass vaccination

This project examines the use of an agent-based modeling tool and development environment to provide real-time decision support and resource allocation for managers and staff of point-of-distribution (POD) locations conducting mass vaccination for epidemic influenza. The simulation testing environment allows depicting the physical POD environment, staffing location and behaviors, patient flow, and resource monitoring and distribution. Various POD optimizations are analyzed and discussed in light of recent public health recommended layouts and resource deployment.

Monitoring vaccine safety: a critical component of every immunisation program

Postmarketing surveillance of vaccine safety requires active input from vaccine providers and health care professionals.

Evaluation of the measles-rubella mass vaccination campaign in the population covered by Tehran University of Medical Sciences

We evaluated the measles-rubella mass vaccination campaign in the Islamic Republic of Iran in December 2003. Vaccination coverage, community awareness of the campaign and the quality of vaccination services were assessed in the population covered by Tehran University of Medical Sciences. At the end of the campaign 96.4% (95% CI: 94.6%-98.2%) of the population sample (n = 390) had been vaccinated. Awareness of the campaign was 80.59% of the sample (n = 190) at the start, rising to 96.8% during and 100.0% at the end of the campaign. None of the 24 vaccination teams sampled were over the threshold for unacceptable performance. The mass media and vaccination teams demonstrated good performance and have achieved their goals.