Did this pandemic trigger a spike in mothers' hesitancy over their children's routine immunizations? -A cross sectional study

Evaluating the impact of COVID-19 on routine childhood immunizations coverage in Zambia

There are growing concerns about the comeback of vaccine-preventable diseases. Epidemics exert shocks which affect other health performance indicators such as routine immunizations. Early model forecasts indicate decreased use of immunization services, which puts children at greater risk. Concerns about an increase in morbidity and mortality for illnesses other than COVID-19, particularly in children missing routine vaccinations, are of public health interest. In this study, we evaluate COVID-19 effects on the uptake of routine immunization in Zambia.This was an interrupted time series study. National data on routine immunization coverage between January 2017 and December 2022 were analyzed. Interrupted time series analysis was performed to quantify changes in immunization utilization. To determine if changes in the underlying patterns of utilization of immunization service were correlated with the commencement of COVID-19, seasonally adjusted segmented Poisson regression model was utilised.Utilization of health services was similar with historical levels prior to the first case of COVID-19. There was a significant drop in immunization coverage for measles dose two (RR, 0.59; 95% CI: 0.43-0.80). A decreased slope was observed in immunization coverage of Rotavirus dose one (RR, 0.97; 95% CI: 0.96-0.98) and Rotavirus dose two (RR, 0.97; 95% CI: 0.96-0.98). A growing slope was observed for Oral Poliovirus two (RR, 1.007; 95% CI: 1.004-1.011) and Oral Poliovirus three (RR, 1.007; 95% CI: 1.002-1011). We also observed a growing slope in BCG Bacille Calmette-Guerin (BCG) (RR, 1.001; 95% CI: 1.000-1011) and Pentavalent one (RR, 1.00; 95% CI: 1.001-1008) and three (RR, 1.004; 95% CI: 1.001-1008).The COVID-19 pandemic has had a number of unintended consequences that have affected the use of immunization services. Ensuring continuity in the provision of health services, especially childhood immunization, during pandemics or epidemics is crucial. Therefore, Investing in robust healthcare infrastructure to withstand surges, training and retaining a skilled workforce capable of handling emergencies and routine services simultaneously is very cardinal to avoid vaccine-preventable diseases, causing long-term health effects especially child mortality.

Specialist nurse's health promotion work with the national childhood immunization programme: A qualitative study

PURPOSE

Childhood immunizations have proven to be one of the most beneficial interventions to promote public health and prevent childhood deaths due to disease. However, global coverage of childhood immunization has decreased throughout the world due to guardians' growing hesitancy towards immunizations. This study aims to describe how specialist nurses promote legal guardians to adhere to national childhood immunization programmes.

DESIGN AND METHODS

This study had a qualitative design. Semistructured interviews with 11 specialist nurses, who were paediatric primary care nurses or nurse practitioners, were conducted. Data were analysed using qualitative content analysis.

RESULTS

The findings, with four main categories including four subcategories, showed nurses using both local guidelines and national guidelines to promote guardians to adhere to the childhood immunization programme. The main intervention the nurses did to promote childhood immunization coverage was giving legal guardians general information about the programme. With hesitant guardians, adopting a person-centred approach towards the legal guardian improved adherence.

PRACTICE IMPLICATIONS

Further research should focus on how specialist nurses can respond to guardians who decline immunization for their children, as this study identified difficulties in this area. Furthermore, research on guardians' perspectives towards childhood immunization may also help generate further effective guidance on how to promote immunization coverage among children.

Assessing vaccine hesitancy and health literacy using a new Italian vaccine confidence index and a modified Italian medical term recognition test: A cross-sectional survey on Italian parents

The decline in children's vaccination coverage and the resurgence of preventable infectious diseases draw attention to parents' vaccine hesitancy. Our study introduces two validated tools to independently assess vaccine hesitancy and health literacy among parents with school-age children. We developed a Vaccine Confidence Index (VCI) from 10 Likert items, exploring their relationships through exploratory and confirmatory factor analyses. We modified the IMETER (Italian medical term recognition test) to measure health literacy. We assessed the internal consistency of the modified IMETER and the 10 Likert items using Cronbach's alpha test (α) and McDonald's omega total coefficient (ω) with good results (ω = 0.92, α = 0.90; ω = 0.87, α = 0.82 respectively). We used these tools within a questionnaire conducted on 743 parents recruited from pediatric clinic waiting rooms in Italy, collecting demographic data, information sources on vaccines and vaccine-preventable diseases knowledge. The VCI resulting from factor analyses consisted of six items on a ten-point Likert scale, reflecting the ratio of positive to negative items. The survey revealed significant variations in the VCI according to individual features such as education, use of social networks, or Health institutions as sources of information. Multivariate logistic regression identified an association between vaccine intention and the VCI. Health literacy was functional for 91.2% of participants, but knowledge about vaccine-preventable diseases was generally low. The VCI showed no significant association with health literacy and vaccine-preventable diseases knowledge. The VCI and the modified IMETER effectively assess vaccination attitude and health literacy, offering valuable public health tools for tailoring vaccination campaigns to hesitant population subgroups.

Why school is crucial to increase vaccination coverage for children: Evaluation of school vaccination check program in South Korea 2021-2022

The School Vaccination Check Program (SVCP) is a public health measure that aims to achieve high levels of National Immunization Program (NIP) vaccination coverage for children by checking the completion of the vaccination schedule for students when they enter elementary or middle school. Due to the COVID-19 pandemic, the SVCP was stopped in 2020 and 2021, and restarted in June-August 2022. In this study, we examined and quantified the relationship with SVCP and the vaccination uptake by comparing the vaccination coverage of 2021 and 2022. Based on the standard schedule, the vaccination records of DTaP5, IPV4, MMR2 and IJEV4 were evaluated for elementary school students. The Tdap6, IJEV5 and HPV1 were evaluated for the students from middle school. Using a difference-in-difference study design and national level big data, the study compared vaccination coverage as of August 2021 and 2022. The study found that the SVCP was effective in increasing vaccination coverage for targeted vaccinations such as DTaP5, IPV4, MMR2 and IJEV4 for elementary school students, and Tdap6, IJEV5 for middle school students. However, the SVCP did not show a statistically significant effect on increasing vaccination coverage on HPV1 for middle school students. School can play an important role to improve vaccination coverage. Therefore, close collaboration with health and education authority is crucial to accomplish successful vaccination program reducing vaccine preventable disease outbreaks in schools.