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Wang Q, Dai P, Jia M, Jiang M, Li J, Yang W, Feng L. Construction of an indicator framework for vaccine inclusion in public health programs: A Delphi-entropy method study. Hum Vaccin Immunother 2023; 19:2272539. [PMID: 37905961 PMCID: PMC10760382 DOI: 10.1080/21645515.2023.2272539] [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: 06/23/2023] [Accepted: 10/16/2023] [Indexed: 11/02/2023] Open
Abstract
Governments must decide which vaccine priority to include in their public health programs. Using the modified Delphi and entropy method, we developed an indicator framework for vaccine inclusion at the national, provincial, municipal, and district/county levels, each containing three dimensions. In total, 4 primary indicators, 17 secondary indicators, and 45 tertiary indicators were selected, covering vaccine-preventable diseases, candidate vaccines, and social drivers of the supply and demand sides. From a subjective perspective, there was no significant weighting difference in the primary and secondary indicators at all administrative levels. "Vaccine-preventable diseases" as a primary indicator had the greatest weight in the peer group, of which "Health burden" had the highest weight among the secondary indicators. From the objective perspective, the social drivers on the supply and demand sides of the primary indicators accounted for 65% and higher. Among the secondary indicators, "the characteristics of the candidate vaccine" and "vaccine-related policies on the supply side" held 8% of weights or more at both national and provincial levels. "Demographic characteristics" held the highest weight at the municipal (13.50) and district/county (15.45) level. This study indicates that China needs different considerations when using WHO-recommended vaccines at the national, provincial, municipal, and district/county levels. In addition, this study highlights that behavioral and social drivers are important indicators that need to be considered for decision-making. This framework provides a tool for policymakers to determine the inclusion priority of candidate vaccines.
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Affiliation(s)
- Qing Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Peixi Dai
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mengmeng Jia
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Mingyue Jiang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Juan Li
- Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, Beijing, China
| | - Weizhong Yang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Luzhao Feng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Abu-Helalah M, Al-Mnayyis A, Alzoubi H, Al-Abdallah R, Jdaitawi H, Nafi O, Abu-Sal K, Altawalbeh A, Khlaifat A, Al-Zayadneh E, Almaaitah I, Borghol I, Batarseh F, Okkeh O, Dalal A, Alhendi A, Almaaitah M, Al-Lahham A, Gazo M, Abu Ekteish F, Elnasser Z. Epidemiology of Streptococcus pneumoniae Serotypes in Jordan Amongst Children Younger than the Age of 5: A National Cross-Sectional Study. Vaccines (Basel) 2023; 11:1396. [PMID: 37766074 PMCID: PMC10536609 DOI: 10.3390/vaccines11091396] [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: 07/09/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Streptococcus pneumoniae infections are a major cause of mortality and morbidity worldwide. In Jordan, pneumococcal conjugate vaccines (PCVs) are not included in the national vaccination program. Due to the current availability of several PCVs, including PCV-10, PCV-13, and PCV-15, along with PCV-20, currently undergoing pediatric approvals globally, the decision to introduce PCVs and their selection should be based on valid local data on the common serotypes of Streptococcus pneumoniae. METHODS This cross-sectional study aimed to identify the frequency of serotypes of Streptococcus pneumoniae in children aged below 5 years hospitalized with invasive pneumococcal diseases (IPDs), including pneumonia, septicemia, and meningitis, during the study's duration in representative areas of Jordan. Serotyping for culture-positive cases was based on the capsular reaction test, known as the Quellung reaction. qPCR was conducted on the blood samples of patients with lobar pneumonia identified via X-ray or on cerebrospinal fluid for those with a positive latex agglutination test for Streptococcus pneumoniae. RESULTS This study was based on the analysis of the serotypes of 1015 Streptococcus pneumoniae cases among children younger than the age of 5: 1006 cases with pneumonia, 6 cases with meningitis, and 3 cases with septicemia. Only 23 culture-positive cases were identified in comparison to 992 lobar pneumonia cases, which were PCR-positive but culture-negative, with a PCR positivity rate of 92%. Serotypes 6B, 6A, 14, and 19F were the most common serotypes identified in this study, with prevalence rates of 16.45%, 13.60%, 12.12%, and 8.18%, respectively. PCV-10, PCV-13, PCV-15, and PCV-20 coverage rates were 45.32%, 61.87%, 64.14%, and 68.47%, respectively. DISCUSSION To the best of our knowledge, this is the largest prospective study from the Middle East and one of the largest studies worldwide showing the serotypes of Streptococcus pneumoniae. It reveals the urgency for the introduction of a PCV vaccination in Jordan, utilizing recently developed vaccines with a broader serotype coverage.
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Affiliation(s)
- Munir Abu-Helalah
- Department of Family and Community Medicine, Faculty of Medicine, Jordan University, Amman 11942, Jordan
| | - Asma’a Al-Mnayyis
- Department of Clinical Sciences, College of Medicine, Yarmouk University, Irbid 21163, Jordan;
| | - Hamed Alzoubi
- Department of Pathology and Microbiology, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid 22110, Jordan; (H.A.); (Z.E.)
| | - Ruba Al-Abdallah
- Medical Department, MENA Center for Research & Development and Internship, Amman 11931, Jordan; (R.A.-A.); (F.B.); (O.O.); (A.D.); (A.A.)
| | - Hussein Jdaitawi
- Ministry of Health, Princess Rahma Pediatrics Hospital, Irbid 21163, Jordan;
| | - Omar Nafi
- Faculty of Medicine, Mutah University, Mutah 61110, Jordan;
| | - Kamel Abu-Sal
- Vaccines Department, Ministry of Health, Amman 11931, Jordan;
| | - Alaa Altawalbeh
- Royal Medical Services, Amman 1193, Jordan; (A.A.); (A.K.); (M.A.)
| | - Alia Khlaifat
- Royal Medical Services, Amman 1193, Jordan; (A.A.); (A.K.); (M.A.)
| | - Enas Al-Zayadneh
- Department of Pediatrics, Faculty of Medicine, Jordan University, Amman 11942, Jordan;
| | - Ihsan Almaaitah
- Pediatrics Department, Zarqa Governmental Hospital, Zarqa 13116, Jordan;
| | | | - Fadi Batarseh
- Medical Department, MENA Center for Research & Development and Internship, Amman 11931, Jordan; (R.A.-A.); (F.B.); (O.O.); (A.D.); (A.A.)
| | - Omar Okkeh
- Medical Department, MENA Center for Research & Development and Internship, Amman 11931, Jordan; (R.A.-A.); (F.B.); (O.O.); (A.D.); (A.A.)
| | - Abdallah Dalal
- Medical Department, MENA Center for Research & Development and Internship, Amman 11931, Jordan; (R.A.-A.); (F.B.); (O.O.); (A.D.); (A.A.)
| | - Ahmad Alhendi
- Medical Department, MENA Center for Research & Development and Internship, Amman 11931, Jordan; (R.A.-A.); (F.B.); (O.O.); (A.D.); (A.A.)
| | | | - Adnan Al-Lahham
- Department of Biomedical Engineering, School of Applied Medical Sciences, German-Jordanian University, Amman 11931, Jordan;
| | - Mahmoud Gazo
- Department of Central Laboratories, Ministry of Health, Amman 11931, Jordan
| | - Faisal Abu Ekteish
- Department of Pediatrics, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid 22110, Jordan;
| | - Ziad Elnasser
- Department of Pathology and Microbiology, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid 22110, Jordan; (H.A.); (Z.E.)
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Ma C, Li J, Wang N, Wang Y, Song Y, Zeng X, Zheng C, An Z, Rodewald L, Yin Z. Prioritization of Vaccines for Inclusion into China’s Expanded Program on Immunization: Evidence from Experts’ Knowledge and Opinions. Vaccines (Basel) 2022; 10:vaccines10071010. [PMID: 35891174 PMCID: PMC9318118 DOI: 10.3390/vaccines10071010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 02/02/2023] Open
Abstract
Background: Vaccine developers in China have made an increasing number of infectious diseases preventable through vaccination. An appropriate decision-making procedure is necessary for making wise decisions on whether to introduce new vaccines into the Expanded Program on Immunization (EPI). When there are several vaccines that could potentially be considered, a scientifically justifiable mechanism is needed for prioritizing and sequencing vaccines for consideration. Methods: We used a modified Delphi technique (MDT) to develop and refine an indicator system to prioritize vaccines and make policy recommendations concerning their introduction into China’s EPI system. From January through May 2021, thirty-nine experts were recruited and participated in a two-round Delphi survey that was based on a set of candidate indicators obtained through a literature review and reference to the WHO vaccine introduction recommendations. Using the resulting indicator system, we conducted a third consultation with a multi-disciplinary group of experts who scored five program-eligible candidate vaccines to determine prioritization and sequencing for consideration of inclusion into the EPI. Results: Response rates of the thirty-nine experts were 100% and 97.4% across the two rounds. Authority coefficients from rounds one to three were over 0.70, reflecting the high accuracy and reliability of the consultation. Coordination coefficients of importance scores for primary, secondary, and tertiary indicators were 0.486, 0.356, 0.275 in round one, and 0.405, 0.340, and 0.236 in round two. According to the scores from 30 experts using our indicator system, the sequence and scores (1–10 scale, 10 highest) of 5 candidate vaccines were varicella (6.91), meningococcal conjugate AC (6.83), Hib (6.74), influenza (6.56), and EV71 (6.17) vaccines. Conclusions: A modified Delphi technique effectively built a scientific, rational, comprehensive, and systematic indicator system for prioritizing vaccine candidates for consideration of inclusion into the EPI. The rank order will be used by the technical working groups of China’s National Immunization Advisory Committee to sequentially develop and present Evidence-to-Recommendation tables for making policy recommendations.
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Affiliation(s)
- Chao Ma
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (C.M.); (J.L.); (Y.W.); (Y.S.); (Z.A.); (L.R.)
| | - Junhong Li
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (C.M.); (J.L.); (Y.W.); (Y.S.); (Z.A.); (L.R.)
| | - Nan Wang
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai 201204, China;
| | - Yamin Wang
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (C.M.); (J.L.); (Y.W.); (Y.S.); (Z.A.); (L.R.)
| | - Yudan Song
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (C.M.); (J.L.); (Y.W.); (Y.S.); (Z.A.); (L.R.)
| | - Xiang Zeng
- Zhuhai Center for Disease Control and Prevention, Zhuhai 519000, China;
- Chinese Field Epidemiology Training Program (CFETP), Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Canjun Zheng
- Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 100050, China;
| | - Zhijie An
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (C.M.); (J.L.); (Y.W.); (Y.S.); (Z.A.); (L.R.)
| | - Lance Rodewald
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (C.M.); (J.L.); (Y.W.); (Y.S.); (Z.A.); (L.R.)
| | - Zundong Yin
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (C.M.); (J.L.); (Y.W.); (Y.S.); (Z.A.); (L.R.)
- Correspondence:
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Healthcare provider perspectives on delivering next generation rotavirus vaccines in five low-to-middle-income countries. PLoS One 2022; 17:e0270369. [PMID: 35737718 PMCID: PMC9223340 DOI: 10.1371/journal.pone.0270369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 06/08/2022] [Indexed: 11/27/2022] Open
Abstract
Background Live oral rotavirus vaccines (LORVs) have significantly reduced rotavirus hospitalizations and deaths worldwide. However, LORVs are less effective in low- and middle-income countries (LMICs). Next-generation rotavirus vaccines (NGRVs) may be more effective but require administration by injection or a neonatal oral dose, adding operational complexity. Healthcare providers (HPs) were interviewed to assess rotavirus vaccine preferences and identify delivery issues as part of an NGRV value proposition. Objective Determine HP vaccine preferences about delivering LORVs compared to injectable (iNGRV) and neonatal oral (oNGRV) NGRVs. Methods 64 HPs from Ghana, Kenya, Malawi, Peru, and Senegal were interviewed following a mixed-method guide centered on three vaccine comparisons: LORV vs. iNGRV; LORV vs. oNGRV; oNGRV vs. iNGRV. HPs reviewed attributes for each vaccine in the comparisons, then indicated and explained their preference. Additional questions elicited views about co-administering iNGRV+LORV for greater public health impact, a possible iNGRV-DTP-containing combination vaccine, and delivering neonatal doses. Results Almost all HPs preferred oral vaccine options over iNGRV, with many emphasizing an aversion to additional injections. Despite this strong preference, HPs described challenges delivering oral doses. Preferences for LORV vs. oNGRV were split, marked by disparate views on rotavirus disease epidemiology and the safety, need, and feasibility of delivering neonatal vaccines. Although overwhelmingly enthusiastic about an iNGRV-DTP-containing combination option, several HPs had concerns. HP views were divided on the feasibility of co-administering iNGRV+LORV, citing challenges around logistics and caregiver sensitization. Conclusion Our findings provide valuable insights on delivering NGRVs in routine immunization. Despite opposition to injectables, openness to co-administering LORV+iNGRV to improve efficacy suggests future HP support of iNGRV if adequately informed of its advantages. Rationales for LORV vs. oNGRV underscore needs for training on rotavirus epidemiology and stronger service integration. Expressed challenges delivering existing LORVs merit further examination and indicate need for improved delivery.
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Ozaltin A, Vaughan K, Tani K, Manzi F, Mai VQ, Van Minh H, Kosen S, Shimp L, Brenzel L, Boonstoppel L. Key Factors Influencing Use of Immunization Cost Evidence in Country Planning and Budgeting Processes: Experiences From Indonesia, Tanzania, and Vietnam. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00264. [PMID: 35294377 PMCID: PMC8885341 DOI: 10.9745/ghsp-d-21-00264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/09/2021] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Kassimu Tani
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Fatuma Manzi
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Vu Quynh Mai
- Hanoi University of Public Health, Hanoi, Vietnam
| | | | - Soewarta Kosen
- National Institute of Health Research and Development, Jakarta, Indonesia
| | | | - Logan Brenzel
- Bill & Melinda Gates Foundation, Washington, DC, USA
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Nagi MA, Luangsinsiri C, Thavorncharoensap M. A systematic review of economic evaluations of vaccines in Middle East and North Africa countries: is existing evidence good enough to support policy decision-making? Expert Rev Pharmacoecon Outcomes Res 2021; 21:1159-1178. [PMID: 34252335 DOI: 10.1080/14737167.2021.1954508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION A vaccine introduction process should be systematic and transparent and take into account many factors, including cost-effectiveness evidence. This study aimed to assess quantity, characteristic, and quality of economic evaluation (EE) studies on vaccines performed in Middle East and North Africa (MENA) countries. AREAS COVERED PubMed and Scopus electronic databases were searched since inception to December 2019 to identify published EE studies of vaccines, which were conducted in the 26 MENA countries. Methodological quality of the included studies was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. EXPERT OPINION Of the 616 studies identified, 46 were included in the review. Most studies (65%) were conducted in Iran, Israel, and Turkey. The most commonly evaluated vaccines were rotavirus vaccine (n = 15; 33%), human Papillomavirus vaccine (n = 8; 17%), and pneumococcal vaccine (n = 7; 15%). We classified 5 (11%), 27 (59%), 12 (26%), and 2 (4%) studies as excellent, good, moderate, and poor quality, respectively. There were limited cost-effectiveness evidences in the region. It is imperative to have local guidelines on good practice and reporting, availability of local data, and funding sources to improve quantity and quality of EE studies of vaccines in the region, thereby, facilitating transparent and consistent decision-making processes.
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Affiliation(s)
- Mouaddh Abdulmalik Nagi
- Doctor of Philosophy Program in Social, Economic, and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.,Faculty of Medical Sciences, Aljanad University for Science and Technology, Taiz, Yemen
| | - Chaisiri Luangsinsiri
- Doctor of Philosophy Program in Social, Economic, and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.,Department of Clinical Pharmacy, Faculty of Pharmacy, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Montarat Thavorncharoensap
- Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Rajathevi, Bangkok, Thailand
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Health System Barriers and Facilitators to Delivering Additional Vaccines through the National Immunisation Programme in China: A Qualitative Study of Provider and Service-User Perspectives. Vaccines (Basel) 2021; 9:vaccines9050476. [PMID: 34066844 PMCID: PMC8151436 DOI: 10.3390/vaccines9050476] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/18/2021] [Accepted: 04/26/2021] [Indexed: 11/17/2022] Open
Abstract
In China, there are two categories of vaccines available from the Chinese Center for Disease Control and associated public health agencies. Extended Program of Immunization (EPI) vaccines are government-funded and non-EPI vaccines are voluntary and paid for out-of-pocket. The government plans to transition some non-EPI vaccines to EPI in the coming years, which may burden public health system capacity, particularly in terms of budget, workforce, supply chains, and information systems. Our study explored vaccinator and caregiver perspectives on introducing non-EPI vaccines into routine immunization and perceived facilitators and barriers affecting this transition. We conducted a qualitative study from a realist perspective, analysing semi-structured interviews with 26 vaccination providers and 160 caregivers in three provinces, selected to represent regional socioeconomic disparities across Eastern, Central, and Western China. Data were analysed thematically, using deductive and inductive coding. Most participants were positive about adding vaccines to the national schedule. Candidate EPI vaccines most frequently recommended by participants were varicella, mumps vaccine, and hand-foot-mouth disease. Providers generally considered existing workspaces, cold-chain equipment, and funding sufficient, but described frontline staffing and vaccine information systems as requiring improvement. This is the first qualitative study to explore interest, barriers, and facilitators related to adding vaccines to China's national schedule from provider and caregiver perspectives. Findings can inform government efforts to introduce additional vaccines, by including efforts to retain and recruit vaccine programme staff and implement whole-process data management and health information systems that allow unified nationwide data collection and sharing.
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Donadel M, Panero MS, Ametewee L, Shefer AM. National decision-making for the introduction of new vaccines: A systematic review, 2010-2020. Vaccine 2021; 39:1897-1909. [PMID: 33750592 PMCID: PMC10370349 DOI: 10.1016/j.vaccine.2021.02.059] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Competing priorities make using a transparent and evidence-based approach important when deciding to recommend new vaccines. We conducted a literature review to document the processes and frameworks for national decision-making on new vaccine introductions and explored which key features have evolved since 2010. METHODS We searched literature published on policymaking related to vaccine introduction from March 2010 to August 2020 in six databases. We screened articles for eligibility with the following exclusion criteria: non-human or hypothetical vaccines, the sole focus on economic evaluation or decision to adopt rather than policy decision-making. We employed nine broad categories of criteria from the 2012 review for categorization and abstracted data on the country, income level, vaccine, and other relevant criteria. RESULTS Of the 3808 unique references screened, 116 met eligibility criteria and were classified as: a) framework of vaccine adoption decision-making (27), b) studies that analyse empirical data on or examples of vaccine adoption decision-making (45), c) theoretical and empirical articles that provide insights into the vaccine policymaking process (44 + 17 already included in the previous categories). Commonly reported criteria for decision-making were the burden of disease; vaccine efficacy/effectiveness, safety; impact on health and non-health outcomes; economic evaluation and cost-effectiveness of alternative interventions. Programmatic and acceptability aspects were not as often considered. Most (50; 82%) of the 61 articles describing the process of vaccine introduction policymaking highlighted the role of country, regional, or global evidence-informed recommendations and a robust national governance as enabling factors for vaccine adoption. CONCLUSIONS The literature on vaccine adoption decision-making has expanded since 2010. We found that policymakers and expert advisory committee members (e.g., National Immunization Technical Advisory Group [NITAG]) increasingly value the interventions based on economic evaluations. The results of this review could guide discussions on evidence-informed immunization decision-making among country, sub-regional, and regional stakeholders.
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Affiliation(s)
- Morgane Donadel
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Maria Susana Panero
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lynnette Ametewee
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA; Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Abigail M Shefer
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Qamar FN, Batool R, Qureshi S, Ali M, Sadaf T, Mehmood J, Iqbal K, Sultan A, Duff N, Yousafzai MT. Strategies to Improve Coverage of Typhoid Conjugate Vaccine (TCV) Immunization Campaign in Karachi, Pakistan. Vaccines (Basel) 2020; 8:E697. [PMID: 33228111 PMCID: PMC7711991 DOI: 10.3390/vaccines8040697] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/16/2020] [Accepted: 11/16/2020] [Indexed: 11/17/2022] Open
Abstract
The emergence and spread of extensively drug-resistant (XDR) typhoid in Karachi, Pakistan led to an outbreak response in Lyari Town, Karachi utilizing a mass immunization campaign with typhoid conjugate vaccine (TCV), Typbar TCV®. The mass immunization campaign, targeted Lyari Town, Karachi, one of the worst affected towns during the XDR typhoid outbreak. Here we describe the strategies used to improve acceptance and coverage of Typbar TCV in Lyari Town, Karachi. The mass immunization campaign with Typbar TCV was started as a school- and hospital-based vaccination campaign targeting children between the age of 6 months to 15 years old. A dose of 0.5 mL Typbar TCV was administered intramuscularly. A mobile vaccination campaign was added to cope with high absenteeism and non-response from parents in schools and to cover children out of school. Different strategies were found to be effective in increasing the vaccination coverage and in tackling vaccine hesitancy. Community engagement was the most successful strategy to overcome refusals and helped to gain trust in the newly introduced vaccine. Community announcements and playing typhoid jingles helped to increase awareness regarding the ongoing typhoid outbreak. Mop-up activity in schools was helpful in increasing coverage. Networking with locally active groups, clubs and community workers were found to be the key factors in decreasing refusals.
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Affiliation(s)
- Farah Naz Qamar
- Department of Pediatrics and Child Health, Aga Khan University Hospital, National Stadium Rd, Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan; (R.B.); (S.Q.); (M.A.); (T.S.); (J.M.); (M.T.Y.)
| | - Rabab Batool
- Department of Pediatrics and Child Health, Aga Khan University Hospital, National Stadium Rd, Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan; (R.B.); (S.Q.); (M.A.); (T.S.); (J.M.); (M.T.Y.)
| | - Sonia Qureshi
- Department of Pediatrics and Child Health, Aga Khan University Hospital, National Stadium Rd, Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan; (R.B.); (S.Q.); (M.A.); (T.S.); (J.M.); (M.T.Y.)
| | - Miqdad Ali
- Department of Pediatrics and Child Health, Aga Khan University Hospital, National Stadium Rd, Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan; (R.B.); (S.Q.); (M.A.); (T.S.); (J.M.); (M.T.Y.)
| | - Tahira Sadaf
- Department of Pediatrics and Child Health, Aga Khan University Hospital, National Stadium Rd, Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan; (R.B.); (S.Q.); (M.A.); (T.S.); (J.M.); (M.T.Y.)
| | - Junaid Mehmood
- Department of Pediatrics and Child Health, Aga Khan University Hospital, National Stadium Rd, Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan; (R.B.); (S.Q.); (M.A.); (T.S.); (J.M.); (M.T.Y.)
| | - Khalid Iqbal
- Kharadar General Hospital, Agha Khan Road, Nawab Mahabat Khanji Rd, Kharadar Karachi, Sindh 74000, Pakistan;
| | - Akram Sultan
- E.P.I Sindh, Ex I.I Depot Rafiqui Shaheedi Road, Karachi Cantonment, Karachi, Sindh 75510, Pakistan;
| | - Noah Duff
- Sabin Vaccine Institute, 2175 K Street, NW, Suite 400, Washington, DC 20037, USA;
| | - Mohammad Tahir Yousafzai
- Department of Pediatrics and Child Health, Aga Khan University Hospital, National Stadium Rd, Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan; (R.B.); (S.Q.); (M.A.); (T.S.); (J.M.); (M.T.Y.)
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Bechini A, Boccalini S, Ninci A, Zanobini P, Sartor G, Bonaccorsi G, Grazzini M, Bonanni P. Childhood vaccination coverage in Europe: impact of different public health policies. Expert Rev Vaccines 2019; 18:693-701. [PMID: 31268739 DOI: 10.1080/14760584.2019.1639502] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Vaccination is a crucial tool for the primary prevention of infectious diseases. Thanks to widespread vaccination, in the last century smallpox has been eradicated, and the Americas and Europe have become polio-free. Areas covered: The aim of our study was to assess vaccination coverage in childhood up to booster preschool age in order to update the analysis on European trends of immunization coverage in the last nine years (2009-2017) and to assess the impact of different national policies on vaccine uptake. Expert opinion: Despite the good results, several EU countries are going through unprecedented outbreaks of vaccine-preventable diseases due to insufficient coverage. The increase of vaccine hesitancy has made it difficult to reach and maintain high rates of vaccination coverage. Enforcing mandatory vaccinations is one of the strategies adopted by some countries, like Italy and France, to increase coverage. However, each country should find the most suitable way to keep up with vaccination coverages according to own cultural and organizational background.
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Affiliation(s)
- Angela Bechini
- a Department of Health Sciences, University of Florence , Florence , Italy
| | - Sara Boccalini
- a Department of Health Sciences, University of Florence , Florence , Italy
| | - Alessandra Ninci
- b Medical Specialization School of Hygiene and Preventive Medicine, University of Florence , Florence , Italy
| | - Patrizio Zanobini
- b Medical Specialization School of Hygiene and Preventive Medicine, University of Florence , Florence , Italy
| | - Gino Sartor
- b Medical Specialization School of Hygiene and Preventive Medicine, University of Florence , Florence , Italy
| | | | - Maddalena Grazzini
- a Department of Health Sciences, University of Florence , Florence , Italy
| | - Paolo Bonanni
- a Department of Health Sciences, University of Florence , Florence , Italy
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Duarte DC, Oliveira VCD, Guimarães EADA, Viegas SMDF. Vaccination access in Primary Care from the user's perspective: senses and feelings about healthcare services. ESCOLA ANNA NERY 2018. [DOI: 10.1590/2177-9465-ean-2018-0250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Objective: To understand the feelings, senses, perceptions and perspectives of Users regarding access to vaccination in Primary Health Care. Method: This is a Holistic-Qualitative Multiple Case Study, based on Comprehensive Sociology of Everyday Life with 74 participants representing four microregions of health in the Western Extended Region of Minas Gerais. Data collection occurred between June 2016 and April 2017. In order to analyse the data, we used the Thematic Content Analysis, obeying the technique of cross-synthesis of the cases. Results: The results reveal the senses perceived by Users in the experience of vaccination and the feelings regarding care, showing that interpersonal relations between population and health professionals are determinant in the access to vaccination. The constant expansion of the official immunization schedule increased access, however, geographical and social aspects, the lack of knowledge about vaccination and the recurrent lack of immunobiological were referred to as barriers to immunization access. Final considerations: We emphasized the need to reinforce more equitable policies and effective communication as a means to promote the credibility of the services with Users.
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The impact and cost-effectiveness of controlling cholera through the use of oral cholera vaccines in urban Bangladesh: A disease modeling and economic analysis. PLoS Negl Trop Dis 2018; 12:e0006652. [PMID: 30300420 PMCID: PMC6177119 DOI: 10.1371/journal.pntd.0006652] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 07/02/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Cholera remains an important public health problem in major cities in Bangladesh, especially in slum areas. In response to growing interest among local policymakers to control this disease, this study estimated the impact and cost-effectiveness of preventive cholera vaccination over a ten-year period in a high-risk slum population in Dhaka to inform decisions about the use of oral cholera vaccines as a key tool in reducing cholera risk in such populations. METHODOLOGY/PRINCIPAL FINDINGS Assuming use of a two-dose killed whole-cell oral cholera vaccine to be produced locally, the number of cholera cases and deaths averted was estimated for three target group options (1-4 year olds, 1-14 year olds, and all persons 1+), using cholera incidence data from Dhaka, estimates of vaccination coverage rates from the literature, and a dynamic model of cholera transmission based on data from Matlab, which incorporates herd effects. Local estimates of vaccination costs minus savings in treatment costs, were used to obtain incremental cost-effectiveness ratios for one- and ten-dose vial sizes. Vaccinating 1-14 year olds every three years, combined with annual routine vaccination of children, would be the most cost-effective strategy, reducing incidence in this population by 45% (assuming 10% annual migration), and costing was $823 (2015 USD) for single dose vials and $591 (2015 USD) for ten-dose vials per disability-adjusted life year (DALY) averted. Vaccinating all ages one year and above would reduce incidence by >90%, but would be 50% less cost-effective ($894-1,234/DALY averted). Limiting vaccination to 1-4 year olds would be the least cost-effective strategy (preventing only 7% of cases and costing $1,276-$1,731/DALY averted), due to the limited herd effects of vaccinating this small population and the lower vaccine efficacy in this age group. CONCLUSIONS/SIGNIFICANCE Providing cholera vaccine to slum populations in Dhaka through periodic vaccination campaigns would significantly reduce cholera incidence and inequities, and be especially cost-effective if all 1-14 year olds are targeted.
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Loze PM, Nasciben LB, Sartori AMC, Itria A, Novaes HMD, de Soárez PC. Vaccines are different: A systematic review of budget impact analyses of vaccines. Vaccine 2017; 35:2781-2793. [DOI: 10.1016/j.vaccine.2017.03.088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 02/23/2017] [Accepted: 03/29/2017] [Indexed: 12/13/2022]
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Sartori AMC, Rozman LM, Decimoni TC, Leandro R, Novaes HMD, de Soárez PC. A systematic review of health economic evaluations of vaccines in Brazil. Hum Vaccin Immunother 2017; 13:1-12. [PMID: 28129026 DOI: 10.1080/21645515.2017.1282588] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In Brazil, since 2005, the Ministry of Health requires Health Economic Evaluation (HEE) of vaccines for introduction into the National Immunization Program. OBJECTIVES To describe and analyze the full HEE on vaccines conducted in Brazil from 1980 to 2013. METHODS Systematic review of the literature. We searched multiple databases. Two researchers independently selected the studies and extracted the data. The methodological quality of individual studies was evaluated using CHEERS items. RESULTS Twenty studies were reviewed. The most evaluated vaccines were pneumococcal (25%) and HPV (15%). The most used types of HEE were cost-effectiveness analysis (45%) and cost-utility analysis (20%). The research question and compared strategies were stated in all 20 studies and the target population was clear in 95%. Nevertheless, many studies did not inform the perspective of analysis or data sources. CONCLUSIONS HEE of vaccines in Brazil has increased since 2008. However, the studies still have methodological deficiencies.
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Affiliation(s)
- Ana Marli Christovam Sartori
- a Departamento de Moléstias Infecciosas e Parasitárias , Faculdade de Medicina, Universidade de São Paulo , São Paulo , Brazil
| | - Luciana Martins Rozman
- b Departamento de Medicina Preventiva , Faculdade de Medicina, Universidade de São Paulo , São Paulo , Brazil
| | - Tassia Cristina Decimoni
- b Departamento de Medicina Preventiva , Faculdade de Medicina, Universidade de São Paulo , São Paulo , Brazil
| | - Roseli Leandro
- b Departamento de Medicina Preventiva , Faculdade de Medicina, Universidade de São Paulo , São Paulo , Brazil
| | | | - Patrícia Coelho de Soárez
- b Departamento de Medicina Preventiva , Faculdade de Medicina, Universidade de São Paulo , São Paulo , Brazil
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Vaccine strategies: Optimising outcomes. Vaccine 2016; 34:6691-6699. [PMID: 27887796 DOI: 10.1016/j.vaccine.2016.10.078] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/12/2016] [Accepted: 10/31/2016] [Indexed: 11/22/2022]
Abstract
Successful immunisation programmes generally result from high vaccine effectiveness and adequate uptake of vaccines. In the development of new vaccination strategies, the structure and strength of the local healthcare system is a key consideration. In high income countries, existing infrastructures are usually used, while in less developed countries, the capacity for introducing new vaccines may need to be strengthened, particularly for vaccines administered beyond early childhood, such as the measles or human papillomavirus (HPV) vaccine. Reliable immunisation service funding is another important factor and low income countries often need external supplementary sources of finance. Many regions also obtain support in generating an evidence base for vaccination via initiatives created by organisations including World Health Organization (WHO), the Pan American Health Organization (PAHO), the Agence de Médecine Préventive and the Sabin Vaccine Institute. Strong monitoring and surveillance mechanisms are also required. An example is the efficient and low-cost approaches for measuring the impact of the hepatitis B control initiative and evaluating achievement of goals that have been established in the WHO Western Pacific region. A review of implementation strategies reveals differing degrees of success. For example, in the Americas, PAHO advanced a measles-mumps-rubella vaccine strategy, targeting different population groups in mass, catch-up and follow-up vaccination campaigns. This has had much success but coverage data from some parts of the region suggest that children are still not receiving all appropriate vaccines, highlighting problems with local service infrastructures. Stark differences in coverage levels are also observed among high income countries, as is the case with HPV vaccine implementation in the USA versus the UK and Australia, reflecting differences in delivery settings. Experience and research have shown which vaccine strategies work well and the factors that encourage success, which often include strong support from government and healthcare organisations, as well as tailored, culturally-appropriate local approaches to optimise outcomes.
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Abstract
PURPOSE OF REVIEW We highlight recent advances relevant to understanding norovirus infections in the tropics, both in populations living in developing settings and travelers to these regions. RECENT FINDINGS Because of the decrease in diarrheal disease associated with the global rollout of vaccines against rotavirus, norovirus is emerging as the predominant cause of diarrhea morbidity among children in the tropics, and evidence suggests that it contributes to adult disease in endemic populations and travelers. In addition to identifying potential target populations for preventive measures, we provide an update on norovirus vaccine development and concepts related to their implementation in low-income and middle-income countries. SUMMARY These current concepts related to norovirus-attributable disease burden, clinical significance, and economic impact can potentially be applied to tailoring efforts to prevent and mitigate the effects of this important enteropathogen.
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Andrus JK, Walker DG. Perspectives on expanding the evidence base to inform vaccine introduction: Program costing and cost-effectiveness analyses. Vaccine 2016; 33 Suppl 1:A2-3. [PMID: 25919161 DOI: 10.1016/j.vaccine.2015.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Jon Kim Andrus
- Sabin Vaccine Institute, 2000 Pennsylvania Avenue, NW Suite 7100, Washington, DC 20006, USA.
| | - Damian G Walker
- Bill and Melinda Gates Foundation, 500 Fifth Avenue, North Seattle, WA 98109, USA.
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Blau J, Hoestlandt C, D Clark A, Baxter L, Felix Garcia AG, Mounaud B, Mosina L. Strengthening national decision-making on immunization by building capacity for economic evaluation: Implementing ProVac in Europe. Vaccine 2016; 33 Suppl 1:A34-9. [PMID: 25919171 DOI: 10.1016/j.vaccine.2014.12.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 12/18/2014] [Accepted: 12/19/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND For many years, low- and middle-income countries have made efforts to strengthen national decision-making on immunization. The Pan American Health Organization (PAHO) ProVac Initiative was established to help expedite the use of evidence-based decision-making around new vaccine introduction. This initiative provides training in user-friendly cost-effectiveness models and supports the development of country-led economic evaluations. Due to the success of the ProVac Initiative in the Americas, and following requests from countries from outside the Americas, the Bill & Melinda Gates Foundation funded a two-year pilot effort to expand the initiative to other world regions. Called the ProVac International Working Group (IWG), this endeavor took place in 2012 and 2013. It was coordinated by PAHO and carried out in collaboration with several international partners, including the Agence de Médecine Préventive (AMP), London School of Hygiene & Tropical Medicine (LSHTM), Program for Appropriate Technology in Health, Sabin Vaccine Institute, United States Centers for Disease Control and Prevention, and the World Health Organization (WHO). In the WHO European Region, technical support was provided by AMP, in close collaboration with the WHO Regional Office for Europe and other ProVac IWG partners. METHODS In 2012, AMP, the WHO Regional Office for Europe, and other partners held a training workshop in Dubrovnik, Croatia, for 31 participants from four countries of the WHO European Region. The aim was to train health professionals in standard methods of economic evaluation and to assess regional demand for economic studies to support decision-making on immunization. AMP and the other organizations also supported four national cost-effectiveness studies in the WHO European Region. The assistance included country visits and support over a period of six months, the establishment of multidisciplinary teams of experts, ongoing training on the TRIVAC decision-support model for new-vaccine economic analysis, review of local evidence, recommending key data inputs, and support in presenting results to national decision makers. RESULTS National cost-effectiveness studies were conducted in four countries: Albania (rotavirus vaccine [RV]), Azerbaijan (pneumococcal conjugate vaccine [PCV]), Croatia (PCV), and Georgia (PCV). All four countries improved their estimates of the burden of disease preventable by the new vaccines. National advisory bodies and ministries of health obtained economic evidence that helped Albania and Croatia to make decisions on introducing the new vaccines. Azerbaijan and Georgia used economic evidence to confirm previously made preliminary decisions to introduce PCV and make corresponding financial commitments. The study helped Albania to obtain access to affordable prices for rotavirus vaccines through participation in the UNICEF procurement mechanism for middle-income countries. Croatia was able to define the PCV price that would make its introduction cost-effective, and can use this figure as a basis for price negotiations. DISCUSSION Despite some challenges due to competing national priorities, tight budgets for immunization, and lack of available national data, the ProVac IWG helped to build capacity of national health professionals, support decision-making for the introduction of new vaccines, and promote utilization of economic evidence for making decisions on immunization. This type of strong collaboration among international partners and countries should be scaled up, given that many other countries in the WHO European Region have expressed interest in receiving assistance from the ProVac IWG.
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Affiliation(s)
- Julia Blau
- Agence de Médecine Préventive, Paris, France.
| | | | - Andrew D Clark
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Louise Baxter
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Liudmila Mosina
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
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Jauregui B, Janusz CB, Clark AD, Sinha A, Garcia AGF, Resch S, Toscano CM, Sanderson C, Andrus JK. ProVac Global Initiative: a vision shaped by ten years of supporting evidence-based policy decisions. Vaccine 2016; 33 Suppl 1:A21-7. [PMID: 25919164 DOI: 10.1016/j.vaccine.2014.12.080] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 12/19/2014] [Accepted: 12/22/2014] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The Pan American Health Organization (PAHO) created the ProVac Initiative in 2004 with the goal of strengthening national technical capacity to make evidence-based decisions on new vaccine introduction, focusing on economic evaluations. In view of the 10th anniversary of the ProVac Initiative, this article describes its progress and reflects on lessons learned to guide the next phase. METHODS We quantified the output of the Initiative's capacity-building efforts and critically assess its progress toward achieving the milestones originally proposed in 2004. Additionally, we reviewed how country studies supported by ProVac have directly informed and strengthened the deliberations around new vaccine introduction. RESULTS Since 2004, ProVac has conducted four regional workshops and supported 24 health economic analyses in 15 Latin American and Caribbean countries. Five Regional Centers of Excellence were funded, resulting in six operational research projects and nine publications. Twenty four decisions on new vaccine introductions were supported with ProVac studies. Enduring products include the TRIVAC and CERVIVAC cost-effectiveness models, the COSTVAC program costing model, methodological guides, workshop training materials and the OLIVES on-line data repository. Ten NITAGs were strengthened through ProVac activities. DISCUSSION The evidence accumulated suggests that initiatives with emphasis on sustainable training and direct support for countries to generate evidence themselves, can help accelerate the introduction of the most valuable new vaccines. International and Regional Networks of Collaborators are necessary to provide technical support and tools to national teams conducting analyses. Timeliness, integration, quality and country ownership of the process are four necessary guiding principles for national economic evaluations to have an impact on policymaking. It would be an asset to have a model that offers different levels of complexity to choose from depending on the vaccine being evaluated, the availability of data, and the time frame of the decision. CONCLUSION Decision support for new vaccine introduction in low- and middle-income countries is critical to maximizing the efficiency and impact of vaccination programs. Global technical cooperation will be required. In the future, PAHO and WHO have an opportunity to expand the reach of the ProVac philosophy, models, and methods to additional regions and countries requiring real-time support. The ProVac Global Initiative is proposed as an effective mechanism to do so.
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Affiliation(s)
- Barbara Jauregui
- Comprehensive Family Immunization, Pan American Health Organization, Washington, DC, USA.
| | - Cara Bess Janusz
- Comprehensive Family Immunization, Pan American Health Organization, Washington, DC, USA
| | - Andrew D Clark
- Health Services, Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Anushua Sinha
- Depatment of Preventive Medicine and Community Health, New Jersey Medical School, Rutgers - The State University of New Jersey, Newark, NJ, USA
| | | | - Stephen Resch
- Center for Health Decision Science, Harvard School of Public Health, Boston, MA, USA
| | | | - Colin Sanderson
- Health Services, Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jon Kim Andrus
- Comprehensive Family Immunization, Pan American Health Organization, Washington, DC, USA
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