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Aizawa Y, Sato I, Abe Y, Sasagawa F, Saitoh A. Impact of the emergence of severe acute respiratory syndrome coronavirus 2 omicron variants on routine childhood immunization in japan. Vaccine 2024:126137. [PMID: 39048467 DOI: 10.1016/j.vaccine.2024.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/11/2024] [Accepted: 07/11/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic disrupted routine childhood vaccination worldwide, especially at the beginning of the pandemic. After the emergence of variants of concern, particularly the Omicron variants, the number of COVID-19 cases significantly increased, especially in children. However, the impact of the Omicron variants on routine childhood vaccination is unknown. METHODS This retrospective observational study collected data on vaccines included in the Japanese national immunization program (NIP) of children 15 years or younger between 2016 and 2022 in Niigata, Japan. During the study period, hepatitis B virus vaccine and rotavirus vaccines were introduced to the NIP in October 2016 and October 2020, respectively. The monthly number of vaccine doses per eligible child population between 2020 and 2022 (pandemic period) was compared to the average number of vaccine doses in the corresponding month between 2016 and 2019 (pre-pandemic period). The effect of 8 surges of COVID-19 patients on trends in routine childhood vaccination was also analyzed. RESULTS The numbers of doses during the pre-Omicron pandemic period were comparable to the values administered before the pandemic. However, after the emergence of the Omicron variants, and especially after the surge of Omicron variant BA.5 in 2022, the number of vaccine doses declined. The decline was notable in second doses of MR vaccine at age 5-6 years by - 9.6 % and diphtheria-tetanus vaccine at ages 11-12 years by - 14.1 %. CONCLUSIONS Routine childhood immunization was significantly affected by the emergence of the Omicron variants most likely due to the facts that more candidates and their guardians contracted COVID-19, or were required isolation for close contacts. The findings highlight the importance of continued monitoring to maintain high coverage of routine childhood immunizations for controlling vaccine preventable diseases. A follow-up study should investigate changes in the number of declined vaccine doses during Omicron variant predominance.
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Affiliation(s)
- Yuta Aizawa
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; The Committee on Immunization, Medical Association of Niigata City, Niigata, Japan.
| | - Isamu Sato
- The Committee on Immunization, Medical Association of Niigata City, Niigata, Japan; Yoiko Pediatric Clinic
| | - Yuki Abe
- The Committee on Immunization, Medical Association of Niigata City, Niigata, Japan; Department of Pediatrics, Niigata City General Hospital, Niigata, Japan
| | - Fujio Sasagawa
- The Committee on Immunization, Medical Association of Niigata City, Niigata, Japan; Sasagawa Pediatric Clinic
| | - Akihiko Saitoh
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Mbunga BK, Liu PY, Bangelesa F, Mafuta E, Dalau NM, Egbende L, Hoff NA, Kasonga JB, Lulebo A, Manirakiza D, Mudipanu A, Mvuama N, Ouma P, Wong K, Lusamba P, Burstein R. Zero-Dose Childhood Vaccination Status in Rural Democratic Republic of Congo: Quantifying the Relative Impact of Geographic Accessibility and Attitudes toward Vaccination. Vaccines (Basel) 2024; 12:617. [PMID: 38932346 PMCID: PMC11209617 DOI: 10.3390/vaccines12060617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/24/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
Despite efforts to increase childhood vaccination coverage in the Democratic Republic of the Congo (DRC), approximately 20% of infants have not started their routine immunization schedule (zero-dose). The present study aims to evaluate the relative influence of geospatial access to health facilities and caregiver perceptions of vaccines on the vaccination status of children in rural DRC. Pooled data from two consecutive nationwide immunization surveys conducted in 2022 and 2023 were used. Geographic accessibility was assessed based on travel time from households to their nearest health facility using the AccessMod 5 model. Caregiver attitudes to vaccination were assessed using the survey question "How good do you think vaccines are for your child?" We used logistic regression to assess the relationship between geographic accessibility, caregiver attitudes toward vaccination, and their child's vaccination status. Geographic accessibility to health facilities was high in rural DRC, with 88% of the population living within an hour's walk to a health facility. Responding that vaccines are "Bad, Very Bad, or Don't Know" relative to "Very Good" for children was associated with a many-fold increased odds of a zero-dose status (ORs 69.3 [95%CI: 63.4-75.8]) compared to the odds for those living 60+ min from a health facility, relative to <5 min (1.3 [95%CI: 1.1-1.4]). Similar proportions of the population fell into these two at-risk categories. We did not find evidence of an interaction between caregiver attitude toward vaccination and travel time to care. While geographic access to health facilities is crucial, caregiver demand appears to be a more important driver in improving vaccination rates in rural DRC.
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Affiliation(s)
- Branly Kilola Mbunga
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa H8Q3+2HV, Democratic Republic of the Congo; (B.K.M.); (F.B.); (E.M.); (N.M.D.); (L.E.); (J.B.K.); (A.L.); (N.M.); (P.L.)
| | - Patrick Y. Liu
- Health and Life Sciences, Gates Ventures, Seattle, WA 98033, USA;
| | - Freddy Bangelesa
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa H8Q3+2HV, Democratic Republic of the Congo; (B.K.M.); (F.B.); (E.M.); (N.M.D.); (L.E.); (J.B.K.); (A.L.); (N.M.); (P.L.)
- Institute of Geography and Geology, University of Würzburg, Am Hubland, 97074 Würzburg, Germany
| | - Eric Mafuta
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa H8Q3+2HV, Democratic Republic of the Congo; (B.K.M.); (F.B.); (E.M.); (N.M.D.); (L.E.); (J.B.K.); (A.L.); (N.M.); (P.L.)
| | - Nkamba Mukadi Dalau
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa H8Q3+2HV, Democratic Republic of the Congo; (B.K.M.); (F.B.); (E.M.); (N.M.D.); (L.E.); (J.B.K.); (A.L.); (N.M.); (P.L.)
| | - Landry Egbende
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa H8Q3+2HV, Democratic Republic of the Congo; (B.K.M.); (F.B.); (E.M.); (N.M.D.); (L.E.); (J.B.K.); (A.L.); (N.M.); (P.L.)
| | - Nicole A. Hoff
- Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA;
| | - Jean Bosco Kasonga
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa H8Q3+2HV, Democratic Republic of the Congo; (B.K.M.); (F.B.); (E.M.); (N.M.D.); (L.E.); (J.B.K.); (A.L.); (N.M.); (P.L.)
| | - Aimée Lulebo
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa H8Q3+2HV, Democratic Republic of the Congo; (B.K.M.); (F.B.); (E.M.); (N.M.D.); (L.E.); (J.B.K.); (A.L.); (N.M.); (P.L.)
| | - Deogratias Manirakiza
- United Nations Children’s Fund (UNICEF) Country Office, Kinshasa M7H9+HQW, Democratic Republic of the Congo; (D.M.); (A.M.)
| | - Adèle Mudipanu
- United Nations Children’s Fund (UNICEF) Country Office, Kinshasa M7H9+HQW, Democratic Republic of the Congo; (D.M.); (A.M.)
| | - Nono Mvuama
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa H8Q3+2HV, Democratic Republic of the Congo; (B.K.M.); (F.B.); (E.M.); (N.M.D.); (L.E.); (J.B.K.); (A.L.); (N.M.); (P.L.)
| | - Paul Ouma
- World Health Organization, 1211 Geneva, Switzerland; (P.O.); (K.W.)
| | - Kerry Wong
- World Health Organization, 1211 Geneva, Switzerland; (P.O.); (K.W.)
| | - Paul Lusamba
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa H8Q3+2HV, Democratic Republic of the Congo; (B.K.M.); (F.B.); (E.M.); (N.M.D.); (L.E.); (J.B.K.); (A.L.); (N.M.); (P.L.)
| | - Roy Burstein
- Bill & Melinda Gates Foundation, Seattle, WA 98109, USA
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Zhang H, Patenaude B, Zhang H, Jit M, Fang H. Global vaccine coverage and childhood survival estimates: 1990-2019. Bull World Health Organ 2024; 102:276-287. [PMID: 38562199 PMCID: PMC10976869 DOI: 10.2471/blt.23.290129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 01/22/2024] [Accepted: 02/08/2024] [Indexed: 04/04/2024] Open
Abstract
Objective To quantify the association between reduction in child mortality and routine immunization across 204 countries and territories from 1990 to 2019. Methods We used child mortality and vaccine coverage data from the Global Burden of Disease Study. We used a modified child survival framework and applied a mixed-effects regression model to estimate the reduction in deaths in children younger than 5 years associated with eight vaccines. Findings Between 1990 and 2019, the diphtheria-tetanus-pertussis (DTP), measles, rotavirus and Haemophilus influenzae type b vaccines were significantly associated with an estimated 86.9 (95% confidence interval, CI: 57.2 to 132.4) million fewer deaths in children younger than 5 years worldwide. This decrease represented a 24.2% (95% CI: 19.8 to 28.9) reduction in deaths relative to a scenario without vaccines. The DTP and measles vaccines averted 46.7 (95% CI: 30.0 to 72.7) million and 37.9 (95% CI: 25.4 to 56.8) million deaths, respectively. Of the total reduction in child mortality associated with vaccines, 84.2% (95% CI: 83.0 to 85.1) occurred in 73 countries supported by Gavi, the Vaccine Alliance, with an estimated 45.4 (95% CI: 29.8 to 69.2) million fewer deaths from 2000 to 2019. The largest reductions in deaths associated with these four vaccines were in India, China, Ethiopia, Pakistan and Bangladesh (in order of the size of reduction). Conclusion Vaccines continue to reduce childhood mortality significantly, especially in Gavi-supported countries, emphasizing the need for increased investment in routine immunization programmes.
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Affiliation(s)
- Haijun Zhang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Bryan Patenaude
- International Vaccine Access Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States of America
| | - Haonan Zhang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, England
| | - Hai Fang
- China Center for Health Development Studies, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
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Mboussou F, Kada S, Danovaro-Holliday MC, Farham B, Gacic-Dobo M, Shearer JC, Bwaka A, Amani A, Ngom R, Vuo-Masembe Y, Wiysonge CS, Impouma B. Status of Routine Immunization Coverage in the World Health Organization African Region Three Years into the COVID-19 Pandemic. Vaccines (Basel) 2024; 12:168. [PMID: 38400151 PMCID: PMC10891650 DOI: 10.3390/vaccines12020168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 02/25/2024] Open
Abstract
Data from the WHO and UNICEF Estimates of National Immunization Coverage (WUENIC) 2022 revision were analyzed to assess the status of routine immunization in the WHO African Region disrupted by the COVID-19 pandemic. In 2022, coverage for the first and third doses of the diphtheria-tetanus-pertussis-containing vaccine (DTP1 and DTP3, respectively) and the first dose of the measles-containing vaccine (MCV1) in the region was estimated at 80%, 72% and 69%, respectively (all below the 2019 level). Only 13 of the 47 countries (28%) achieved the global target coverage of 90% or above with DTP3 in 2022. From 2019 to 2022, 28.7 million zero-dose children were recorded (19.0% of the target population). Ten countries in the region accounted for 80.3% of all zero-dose children, including the four most populated countries. Reported administrative coverage greater than WUENIC-reported coverage was found in 19 countries, highlighting routine immunization data quality issues. The WHO African Region has not yet recovered from COVID-19 disruptions to routine immunization. It is critical for governments to ensure that processes are in place to prioritize investments for restoring immunization services, catching up on the vaccination of zero-dose and under-vaccinated children and improving data quality.
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Affiliation(s)
- Franck Mboussou
- World Health Organization, Regional Office for Africa, Brazzaville P.O. Box 06, Congo
| | | | | | - Bridget Farham
- World Health Organization, Regional Office for Africa, Brazzaville P.O. Box 06, Congo
| | - Marta Gacic-Dobo
- World Health Organization Headquarters, Avenue Appia 20, 1211 Geneva, Switzerland
| | | | - Ado Bwaka
- World Health Organization, Regional Office for Africa, Brazzaville P.O. Box 06, Congo
| | - Adidja Amani
- World Health Organization, Regional Office for Africa, Brazzaville P.O. Box 06, Congo
| | - Roland Ngom
- World Health Organization, Regional Office for Africa, Brazzaville P.O. Box 06, Congo
| | - Yolande Vuo-Masembe
- World Health Organization, Regional Office for Africa, Brazzaville P.O. Box 06, Congo
| | - Charles Shey Wiysonge
- World Health Organization, Regional Office for Africa, Brazzaville P.O. Box 06, Congo
| | - Benido Impouma
- World Health Organization, Regional Office for Africa, Brazzaville P.O. Box 06, Congo
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Briga M, Goult E, Brett TS, Rohani P, Domenech de Cellès M. Maternal pertussis immunization and the blunting of routine vaccine effectiveness: a meta-analysis and modeling study. Nat Commun 2024; 15:921. [PMID: 38297003 PMCID: PMC10830464 DOI: 10.1038/s41467-024-44943-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024] Open
Abstract
A key goal of pertussis control is to protect infants too young to be vaccinated, the age group most vulnerable to this highly contagious respiratory infection. In the last decade, maternal immunization has been deployed in many countries, successfully reducing pertussis in this age group. Because of immunological blunting, however, this strategy may erode the effectiveness of primary vaccination at later ages. Here, we systematically reviewed the literature on the relative risk (RR) of pertussis after primary immunization of infants born to vaccinated vs. unvaccinated mothers. The four studies identified had ≤6 years of follow-up and large statistical uncertainty (meta-analysis weighted mean RR: 0.71, 95% CI: 0.38-1.32). To interpret this evidence, we designed a new mathematical model with explicit blunting mechanisms and evaluated maternal immunization's short- and long-term impact on pertussis transmission dynamics. We show that transient dynamics can mask blunting for at least a decade after rolling out maternal immunization. Hence, the current epidemiological evidence may be insufficient to rule out modest reductions in the effectiveness of primary vaccination. Irrespective of this potential collateral cost, we predict that maternal immunization will remain effective at protecting unvaccinated newborns, supporting current public health recommendations.
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Affiliation(s)
- Michael Briga
- Infectious Disease Epidemiology Group, Max Planck Institute for Infection Biology, Berlin, Germany.
| | - Elizabeth Goult
- Infectious Disease Epidemiology Group, Max Planck Institute for Infection Biology, Berlin, Germany
| | - Tobias S Brett
- Odum School of Ecology, University of Georgia, Athens, GA, 30602, USA
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, 30602, USA
| | - Pejman Rohani
- Odum School of Ecology, University of Georgia, Athens, GA, 30602, USA
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, 30602, USA
- Center of Ecology of Infectious Diseases, University of Georgia, Athens, GA, 30602, USA
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Evans B, Keiser O, Kaiser L, Jombart T. Analysis of global routine immunisation coverage shows disruption and stagnation during the first two-years of the COVID-19 pandemic with tentative recovery in 2022. Vaccine X 2023; 15:100383. [PMID: 37841654 PMCID: PMC10568411 DOI: 10.1016/j.jvacx.2023.100383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 08/24/2023] [Accepted: 09/05/2023] [Indexed: 10/17/2023] Open
Abstract
Whilst it is now widely recognised that routine immunisation (RI) was disrupted by the COVID-19 pandemic in 2020, and further so in 2021, the extent of continued interruptions in 2022 and/or rebounds to previous trends remains unclear. We modelled country-specific RI trends using validated estimates of national coverage from the World Health Organisation and United Nation Children's Fund for 182 countries (accounting for > 97% of children globally), to project expected diphtheria, tetanus, and pertussis-containing vaccine first-dose (DTP1), third-dose (DTP3) and measles-containing vaccine first-dose (MCV1) coverage for 2020-2022 based on pre-pandemic trends (from 2000 to 2019). We provide further evidence of peak pandemic immunisation disruption in 2021, followed by tentative recovery in 2022. We report a 3.4% (95 %CI: [2.5%; 4.4%]) decline in global DTP3 coverage in 2021 compared to 2000-2019 trends, from an expected 89.8% to reported 86.4%. This coverage gap reduced to a 2.7% (95 %CI: [1.8%; 3.6%]) decline in 2022, with reported coverage rising to 87.2%. Similar results were seen for DTP1 and MCV1. Whilst partial rebounds are encouraging, global coverage decline translates to a 17-year setback in RI to 2005 levels, and the majority of countries retain coverage at or lower than pre-pandemic levels. The Americas, Africa, and Asia were the most impacted regions; and low- and middle-income countries the most affected income groups. The number of annual Zero Dose (ZD) children - indicating those receiving no immunisations - increased from 12.1 million (M) globally in 2019 to a peak of 16.7 M in 2021, then reduced to 13.1 M in 2022. Overall, we estimate an excess of 8.8 M ZD children cumulatively in 2020-2022 compared to pre-pandemic levels. This work can be used as an objective baseline to inform future interventions to prioritise and target interventions, and facilitate catch-up of growing populations of under- and un-immunised children.
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Affiliation(s)
- Beth Evans
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Olivia Keiser
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Laurent Kaiser
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Thibaut Jombart
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, UK
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